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CLINICAL RESEARCH: HEART RHYTHM DISORDER

The Frequency and Incremental Cost of Major Complications Among Medicare Beneficiaries Receiving Implantable Cardioverter-Defibrillators

Matthew R. Reynolds, MD, MSc^_*,_*, David J. Cohen, MD, MSc^_*, Aaron D. Kugelmass, MD, Phillip P. Brown, MD, Edmund R. Becker, PhD, Steven D. Culler, PhD and April W. Simon, MSN^||

^_* Beth Israel Deaconess Medical Center, Boston, Massachusetts
Henry Ford Hospital, Detroit, Michigan
Centennial Medical Center, Nashville, Tennessee
Emory University, Atlanta, Georgia
^|| Cardiac Data Solutions, Atlanta, Georgia.

Manuscript received October 18, 2005; revised manuscript received February 8, 2006, accepted February 14, 2006.

^_* Reprint requests and correspondence: Dr. Matthew R. Reynolds, Division of Cardiology, Baker 4, Beth Israel Deaconess Medical Center, 185 Pilgrim Road, Boston, Massachusetts 02215. (Email: mreynold{at}bidmc.harvard.edu).

OBJECTIVES: We aimed to quantify the frequency and nature of early complications after implantable cardioverter-defibrillator (ICD) implantation in general practice, and estimate the incremental costs of those complications to the health care system.

BACKGROUND: Cardioverter-defibrillator implantation rates are rising quickly. Little has been published regarding the outcomes and costs of these procedures in unselected populations.

METHODS: Using Medicare Provider Analysis and Review (MedPAR) files, we identified 30,984 admissions containing procedure codes for new ICD or cardiac resynchronization therapy defibrillator implantation in fiscal year 2003. The frequencies of eight complicating diagnoses during these admissions were determined. Length of stay (LOS) and total hospital costs, derived using whole-hospital cost to charge ratios, were calculated for each admission. The incremental effects of any and each complication on LOS and hospital cost were estimated in multivariable models, adjusting for demographic factors and comorbid conditions.

RESULTS: The mean cost for all admissions was $42,184 (median $37,902) with mean LOS of 4.7 days (median 2.0 days). One or more complications were coded in 10.8% of admissions, most commonly "mechanical complication of the ICD" and hemorrhage/hematoma. The occurrence of any complication increased adjusted LOS by 3.4 days and costs by $7,251. Each of the individual complications was associated with highly significant increases in both LOS (1 to 10 days) and hospital cost ($5,000 to $20,000).

CONCLUSIONS: In fiscal 2003, 10.8% of Medicare patients undergoing cardioverter-defibrillator implantation experienced one or more early complications, associated with significant increases in LOS and costs. Efforts to reduce these complications could have significant clinical and financial benefits.

Abbreviations and Acronyms   CMS = Centers for Medicare and Medicaid Services   CRT-D = cardiac resynchronization therapy-defibrillator   ICD = implantable cardioverter-defibrillator   ICD-9-CM = International Classification of Diseases-9th revision-Clinical Modification   LOS = length of stay   MEDPAR = Medicare Provider Analysis and Review

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