The Frequency and Incremental Cost of Major Complications Among Medicare Beneficiaries Receiving Implantable Cardioverter-Defibrillators
Key result
Early ICD complications affect ~11% of Medicare admissions, linked to longer stays and higher costs.
- n=30,984
Why the study?
ICD implantation rates are rising quickly, but little has been published regarding outcomes and costs of these procedures in unselected populations.
What is the frequency and incremental cost of early complications after ICD implantation in Medicare beneficiaries?
Population
30,984 admissions for new ICD or cardiac resynchronization therapy defibrillator implantation
Comparison
Admissions with vs without early complications
Design
Retrospective database analysis of Medicare Provider Analysis and Review files
Authors
Discussion
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Implication
ICD complications were associated with major increases in resource utilization; leaves open whether rates have fallen with device and technique advances.
Key Points
- This research aims to quantify early complications following ICD implantation and assess their incremental costs.
- Analyzed Medicare Provider Analysis and Review files for 30,984 ICD implantation admissions in fiscal year 2003.
- Determined frequencies of eight complications during admissions and calculated length of stay and costs.
- Estimated incremental effects of complications on hospital costs and length of stay using multivariable models.
- 10.8% of admissions reported one or more complications, with primary complications being mechanical issues and hematomas.
- Complications increased the average length of stay by 3.4 days and costs by $7,251, with individual complications raising costs between $5,000 to $20,000.
- The mean cost of admissions was $42,184, with a median length of stay of 4.7 days.
Study Design
Type
Observational (n=30,984)
Multicenter
Yes
Structured PICO
What is the frequency and incremental cost of early complications after ICD implantation in Medicare beneficiaries?
P
Population
30,984 Medicare beneficiaries (admissions) undergoing new implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator implantation in fiscal year 2003
I
Intervention
Implantable cardioverter-defibrillator (ICD) or cardiac resynchronization therapy defibrillator implantation
O
Outcome
Frequency of eight complicating diagnoses during admission, length of stay (LOS), and total hospital costssafety
Early complications after ICD implantation in Medicare beneficiaries are common (10.8%) and associated with significant increases in length of stay and hospital costs.
Cite This Study
Reynolds et al. (2006) conducted an observational in Implantable cardioverter-defibrillator (ICD) implantation (n=30,984). Implantable cardioverter-defibrillator (ICD) or CRT-D implantation vs. Patients without complications was evaluated on Frequency of early complications, length of stay, and total hospital costs. Early complications after ICD implantation occurred in 10.8% of Medicare admissions, significantly increasing adjusted length of stay by 3.4 days and hospital costs by $7,251.