Incidence, predictors and outcomes of hematoma after ICD implantation: An analysis of a nationwide database of 85,276 patients

Abstract

BackgroundPocket hematoma is one of the most common complications following cardiac device implantation. This study examined the impact of this complication on in-hospital outcomes following Implantable Cardioverter Defibrillator (ICD) implantation.MethodsData from Nationwide Inpatient Sample (NIS) 2010 was queried to identify all primary implantations of ICDs and Cardiac Resynchronization Therapy Defibrillators (CRT-D) during the year 2010 using ICD-9 codes. We then identified the patients who experienced a procedure related hematoma during the hospital stay. We compared the outcomes of the patients with and without a hematoma complication. All analyses were performed using SPSS 20 complex samples using appropriate weights to adjust for the complex sampling design of the national database.ResultsOut of a total of 85,276 primary ICD implantations in the year 2010, 2233 (2.6% of the implantations) were complicated by a hematoma. Increased age (p < 0.001), and comorbidities such as congestive heart failure (odds ratio (OR) – 1.86, p < 0.001), coagulopathy (OR - 2.3, p < 0.001) and renal failure (OR - 1.52, p < 0.001) were associated with an increased risk of pocket hematoma formation. Patients who developed a hematoma had a longer hospitalization (9.1 days versus 5.5 days, p < 0.001) and higher in-hospital costs ($56,545 versus $47,015, p < 0.001) compared to patients who did not have a hematoma. Overall mortality associated with ICD implantation was low (0.6%), and hematoma formation did not adversely affect mortality (0.6% versus 0.4%, p = 0.63).ConclusionHematoma occurs infrequently after ICD implantation, however, it adversely impacts the cost of procedure and length of stay.

Identifying the predictors of hematoma after device implantation: Closing in on the suspects with an aim to prevent the menace?

“…in their retrospective analysis of more than 85000 patients found that higher age, congestive heart failure, coagulopathy and renal dysfunction had a higher incidence of hematoma formation after primary or de novo ICD or CRT-D implantation [3]. This is in general in line with the other published data in the literature [4], [6].…”

“…The authors in their study also looked at the short term impact of hematoma formation and found that it increased the length of hospital stay and the cost of hospitalization [3]. Though, there was no significant increase in in-hospital mortality in their study but the actual impact on mortality can only be assessed over long-term taking into account risk of infection attributed by hematoma formation.…”

“…should be complemented for analysing one of the largest databases of ICD and CRT-D recipients and presenting the data on the incidence, predictors and short-term in-hospital outcomes of pocket hematoma [3]. It is reassuring to know that the incidence of hematoma after these implants (2.6%) is not alarmingly high and comparable to many similar studies [4] although, the incidence is quite variable in the literature due to absence of a standard definition of diagnosis of hematoma.…”

Retropectoral hematoma: A rare complication following biventricular implantable cardiac defibrillator upgrade

“…Bleeding in the pocket can lead to significant discomfort, increases risk of infection, and may require surgical drainage. While hematoma formation has not been associated with increased mortality it can lead to increased length of stay and costs of hospitalizations 2 .There are multiple sources from which bleeding in the pocket may occur and result in hematoma formation. These include injury to superficial veins, vascular breast tissue, insertion site vessel, and muscular arterial branches.…”

Device implantation for patients on antiplatelets and anticoagulants: Use of suction drain

“…A significant proportion of them are on antithrombotic therapy (anticoagulant, antiplatelet agents or both) 4, 5, 6. Pocket hematoma is a well recognized complication associated with CIED procedures and its risk is significantly higher when patients are on antithrombotic therapy 7, 8, 9, 10. It also increases the risk of infection in patients undergoing CIED implantations 11, 12, 13.…”