Predictors, Morbidity, and Costs Associated with Pneumothorax during Electronic Cardiac Device Implantation

John Kotter, Georges Lolay, Richard Charnigo, Steve Leung, Christopher Mckibbin, Matthew Sousa, Luis Jimenez, John Gurley, Luigi Di Biase, Andrea Natale, Susan Smyth, Yousef Darrat, Gustavo Morales, Claude S. Elayi

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Pneumothorax (PTX) is a major cause of morbidity associated with cardiac implantable electronic devices (CIEDs). We sought to evaluate predictors of PTX at our centers during CIED implantations, including the venous access technique utilized, as well as to determine morbidity and costs associated with PTX. Methods: We reviewed records of all patients undergoing cardiac device implant or revision with new venous access at our institutions between 2008 and 2014. Common demographic and procedure characteristics were collected including age, sex, body mass index (BMI), comorbidities, and method of venous access (axillary vein vs classic proximal subclavian vein technique). Results: We identified 1,264 patients who met criteria for our analysis, with a total of 21 PTX cases during CIED implantation. The strongest predictor for PTX was the venous access strategy: 0 of 385 (0%) patients with axillary vein approach versus 21 of 879 (2.4%) with traditional subclavian vein approach, P = 0.0006. Additional predictors of PTX included advanced age, female sex, low BMI, and a new device implant (vs device upgrade). The occurrence of PTX was associated with increased length of stay: 3.0 days (median; interquartile range [IQR] 3) versus 1.0 day (median; IQR: 1), P = 0.0001, with a cost increase of 361.4%. Conclusion: An axillary vein vascular access strategy was associated with greatly reduced risk of iatrogenic PTX versus the traditional subclavian approach for CIED placement. Similarly, device upgrade with patent vascular access carried less risk of PTX compared to new device implantation. PTX occurrence significantly prolonged hospitalization and increased costs.

Original languageEnglish (US)
Pages (from-to)985-991
Number of pages7
JournalPACE - Pacing and Clinical Electrophysiology
Volume39
Issue number9
DOIs
StatePublished - Sep 1 2016

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Pneumothorax
Morbidity
Costs and Cost Analysis
Equipment and Supplies
Axillary Vein
Subclavian Vein
Blood Vessels
Body Mass Index
Comorbidity
Length of Stay
Hospitalization
Demography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Predictors, Morbidity, and Costs Associated with Pneumothorax during Electronic Cardiac Device Implantation. / Kotter, John; Lolay, Georges; Charnigo, Richard; Leung, Steve; Mckibbin, Christopher; Sousa, Matthew; Jimenez, Luis; Gurley, John; Di Biase, Luigi; Natale, Andrea; Smyth, Susan; Darrat, Yousef; Morales, Gustavo; Elayi, Claude S.

In: PACE - Pacing and Clinical Electrophysiology, Vol. 39, No. 9, 01.09.2016, p. 985-991.

Research output: Contribution to journalArticle

Kotter, J, Lolay, G, Charnigo, R, Leung, S, Mckibbin, C, Sousa, M, Jimenez, L, Gurley, J, Di Biase, L, Natale, A, Smyth, S, Darrat, Y, Morales, G & Elayi, CS 2016, 'Predictors, Morbidity, and Costs Associated with Pneumothorax during Electronic Cardiac Device Implantation', PACE - Pacing and Clinical Electrophysiology, vol. 39, no. 9, pp. 985-991. https://doi.org/10.1111/pace.12901
Kotter, John ; Lolay, Georges ; Charnigo, Richard ; Leung, Steve ; Mckibbin, Christopher ; Sousa, Matthew ; Jimenez, Luis ; Gurley, John ; Di Biase, Luigi ; Natale, Andrea ; Smyth, Susan ; Darrat, Yousef ; Morales, Gustavo ; Elayi, Claude S. / Predictors, Morbidity, and Costs Associated with Pneumothorax during Electronic Cardiac Device Implantation. In: PACE - Pacing and Clinical Electrophysiology. 2016 ; Vol. 39, No. 9. pp. 985-991.
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abstract = "Background: Pneumothorax (PTX) is a major cause of morbidity associated with cardiac implantable electronic devices (CIEDs). We sought to evaluate predictors of PTX at our centers during CIED implantations, including the venous access technique utilized, as well as to determine morbidity and costs associated with PTX. Methods: We reviewed records of all patients undergoing cardiac device implant or revision with new venous access at our institutions between 2008 and 2014. Common demographic and procedure characteristics were collected including age, sex, body mass index (BMI), comorbidities, and method of venous access (axillary vein vs classic proximal subclavian vein technique). Results: We identified 1,264 patients who met criteria for our analysis, with a total of 21 PTX cases during CIED implantation. The strongest predictor for PTX was the venous access strategy: 0 of 385 (0{\%}) patients with axillary vein approach versus 21 of 879 (2.4{\%}) with traditional subclavian vein approach, P = 0.0006. Additional predictors of PTX included advanced age, female sex, low BMI, and a new device implant (vs device upgrade). The occurrence of PTX was associated with increased length of stay: 3.0 days (median; interquartile range [IQR] 3) versus 1.0 day (median; IQR: 1), P = 0.0001, with a cost increase of 361.4{\%}. Conclusion: An axillary vein vascular access strategy was associated with greatly reduced risk of iatrogenic PTX versus the traditional subclavian approach for CIED placement. Similarly, device upgrade with patent vascular access carried less risk of PTX compared to new device implantation. PTX occurrence significantly prolonged hospitalization and increased costs.",
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T1 - Predictors, Morbidity, and Costs Associated with Pneumothorax during Electronic Cardiac Device Implantation

AU - Kotter, John

AU - Lolay, Georges

AU - Charnigo, Richard

AU - Leung, Steve

AU - Mckibbin, Christopher

AU - Sousa, Matthew

AU - Jimenez, Luis

AU - Gurley, John

AU - Di Biase, Luigi

AU - Natale, Andrea

AU - Smyth, Susan

AU - Darrat, Yousef

AU - Morales, Gustavo

AU - Elayi, Claude S.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Background: Pneumothorax (PTX) is a major cause of morbidity associated with cardiac implantable electronic devices (CIEDs). We sought to evaluate predictors of PTX at our centers during CIED implantations, including the venous access technique utilized, as well as to determine morbidity and costs associated with PTX. Methods: We reviewed records of all patients undergoing cardiac device implant or revision with new venous access at our institutions between 2008 and 2014. Common demographic and procedure characteristics were collected including age, sex, body mass index (BMI), comorbidities, and method of venous access (axillary vein vs classic proximal subclavian vein technique). Results: We identified 1,264 patients who met criteria for our analysis, with a total of 21 PTX cases during CIED implantation. The strongest predictor for PTX was the venous access strategy: 0 of 385 (0%) patients with axillary vein approach versus 21 of 879 (2.4%) with traditional subclavian vein approach, P = 0.0006. Additional predictors of PTX included advanced age, female sex, low BMI, and a new device implant (vs device upgrade). The occurrence of PTX was associated with increased length of stay: 3.0 days (median; interquartile range [IQR] 3) versus 1.0 day (median; IQR: 1), P = 0.0001, with a cost increase of 361.4%. Conclusion: An axillary vein vascular access strategy was associated with greatly reduced risk of iatrogenic PTX versus the traditional subclavian approach for CIED placement. Similarly, device upgrade with patent vascular access carried less risk of PTX compared to new device implantation. PTX occurrence significantly prolonged hospitalization and increased costs.

AB - Background: Pneumothorax (PTX) is a major cause of morbidity associated with cardiac implantable electronic devices (CIEDs). We sought to evaluate predictors of PTX at our centers during CIED implantations, including the venous access technique utilized, as well as to determine morbidity and costs associated with PTX. Methods: We reviewed records of all patients undergoing cardiac device implant or revision with new venous access at our institutions between 2008 and 2014. Common demographic and procedure characteristics were collected including age, sex, body mass index (BMI), comorbidities, and method of venous access (axillary vein vs classic proximal subclavian vein technique). Results: We identified 1,264 patients who met criteria for our analysis, with a total of 21 PTX cases during CIED implantation. The strongest predictor for PTX was the venous access strategy: 0 of 385 (0%) patients with axillary vein approach versus 21 of 879 (2.4%) with traditional subclavian vein approach, P = 0.0006. Additional predictors of PTX included advanced age, female sex, low BMI, and a new device implant (vs device upgrade). The occurrence of PTX was associated with increased length of stay: 3.0 days (median; interquartile range [IQR] 3) versus 1.0 day (median; IQR: 1), P = 0.0001, with a cost increase of 361.4%. Conclusion: An axillary vein vascular access strategy was associated with greatly reduced risk of iatrogenic PTX versus the traditional subclavian approach for CIED placement. Similarly, device upgrade with patent vascular access carried less risk of PTX compared to new device implantation. PTX occurrence significantly prolonged hospitalization and increased costs.

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