Key result
Pacemaker implantation is associated with ~1.5% in-hospital mortality, driven by comorbidities rather than the procedure.
Why the study?
Does in-hospital mortality accurately reflect procedural quality in patients undergoing permanent pacemaker implantation?
Observational (n=5,079)
Yes
Does in-hospital mortality accurately reflect procedural quality in patients undergoing permanent pacemaker implantation?
In-hospital mortality after pacemaker implantation is primarily driven by underlying comorbidities rather than procedural complications, suggesting it is a poor metric for public reporting of hospital quality.
In-hospital mortality may poorly indicate PPM procedural quality; leaves open validation of comorbidity-adjusted metrics in prospective cohorts.
AIMS: To evaluate if public reporting of pacemaker implantation-associated mortality is meaningful in a large contemporary patient cohort. METHODS AND RESULTS: The database of the obligatory external quality control programme in the Federal State of Hessen, Germany, of patients undergoing permanent pacemaker (PPM) implantation was evaluated retrospectively. We compared the baseline features of patients who died compared with those who did not during hospitalization after PPM. Of 5079 patients who underwent PPM implantation in 2009, 74 (1.5%) died during the hospital stay. Cause of death was available in 70/74 patients (94.6%) who died. Deceased patients were older (79.6 ± 8.7 vs. 76.3 ± 9.9 years, P = 0.006), had worse American Society of Anesthesiologists (ASA) physical status (P < 0.001), lower ejection fraction (P < 0.001), a greater prevalence of high-degree atrioventricular-block (44.3 vs. 35.0%, P = 0.001), and were more likely to receive single-chamber devices (41.4 vs. 25.0%, P < 0.002). Perioperative complications were similar in both cohorts. Death was not attributable directly to PPM procedure in any patients but was related to (i) non-device-related infections (28.6%), (ii) heart failure (25.7%), (iii) extracardiac diseases (21.4%), (iv) multiorgan failure (8.6%), (v) previous resuscitation with hypoxic brain damage (8.6%), and (vi) arrhythmogenic death (7.1%). CONCLUSION: Mortality associated with PPM implantation in vast majority of cases was not related to the procedure, but to comorbidities and other existing diseases at the time of PPM implantation. Thus, PPM implantation in-hospital mortality should not be chosen for public reporting comparing hospital quality, even after adjusting for baseline risk.
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Nowak et al. (2016) conducted an observational in Permanent pacemaker implantation (n=5,079). Permanent pacemaker (PPM) implantation was evaluated on In-hospital mortality. Permanent pacemaker implantation was associated with a 1.5% in-hospital mortality rate, which was driven entirely by comorbidities and non-device-related causes rather than the procedure itself.
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