Introduction:
Hospital readmission after pacemaker or cardioverter/defibrillator procedure (insertion, revision, replacement or removal) has a major impact on quality of patient’s life and cost-effectiveness of care. However, the data for 30-day readmission for patients undergoing these procedures is very limited.
Methods:
We queried Agency of Healthcare Research and Quality sponsored Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample (NIS) data using Clinical Classification Software procedure Code 48 for insertion, revision, replacement and removal of cardiac pacemaker or cardioverter/defibrillator, which included ICD 9 codes of 00.50, 00.51, 00.52, 00.53, 00.54, 00.56, 00.57, 17.51, 17.52, 37.70, 37.71, 37.72, 37.73, 37.74, 37.75, 37.76, 37.77, 37.78, 37.79, 37.80, 37.81, 37.82, 37.83, 37.85, 37.86, 37.87, 37.89, 37.94, 37.95, 37.96, 37.97 and 37.98 to extract data for admissions secondary to pacemaker or cardioverter/defibrillator procedure. NIS represents 20% of all hospital data in US. Data was extracted for years 2009-2011 and 30-day readmissions secondary to these procedures identified. Statistical analysis was done using chi-square to determine parameters associated with increased 30-day readmissions.
Results:
We identified 443,719 admission for pacemaker or cardioverter/defibrillator procedure during the study period with total 30-day readmission rate of 15.38%. Females (15.91%), patients aged more than 65 years (15.78%), patients under Medicaid (17.65%), having low median income for zip code (16.44%) and staying in metropolitan areas (15.71%) were more likely to have total 30-day readmissions than other groups (P<0.01). Most common cause for readmission was congestive heart failure in 14,042 patients (20.57%), followed by complication of device in 8,244 patients (12.08%), arrhythmia in 5,750 patients (8.43%). Septicemia was responsible for readmission in 2,346 patients (3.44%)
Conclusions:
Strategies to reduce 30-day readmissions secondary to pacemaker or cardioverter/defibrillator procedure should be focused on more susceptible population including females, aged more than 65 years, covered under Medicaid, having low median income for zip code and staying in metropolitan areas and stringent control of risk factors for congestive heart failure and arrhythmia.
Concept Design and Analysis of Self Sustainable Triboelectric Pacemaker
