Postimplantation pocket hematoma increases risk of cardiac implantable electronic device infection: A meta‐analysis

Abstract

Introduction Several studies have shown an inconsistent relationship between postimplantation pocket hematoma and cardiac implantable electronic device (CIED) infection. In this study, we performed a systematic review and meta‐analysis to explore the effect of postimplantation hematoma and the risk of CIED infection. Methods We searched the databases of MEDLINE and EMBASE from inception to March 2020. Included studies were cohort studies, case‐control studies, cross‐sectional studies, and randomized controlled trials that reported incidence of postimplantation pocket hematoma and CIED infection during the follow‐up period. CIED infection was defined as either a device‐related local or systemic infection. Data from each study were combined using the random effects, generic inverse variance method of Der Simonian and Laird to calculate odds ratios (OR) and 95% confidence intervals (CI). Results Fourteen studies were included in final analysis, involving a total of 28 319 participants. In random‐effect model, we found that postimplantation pocket hematoma significantly increases the risk of overall CIED infection (OR = 6.30, 95% CI: 3.87‐10.24, I2 = 49.3%). There was no publication bias observed in the funnel plot as well as no small‐study effect observed in Egger’s test. Conclusions Our meta‐analysis demonstrated that postimplantation pocket hematoma significantly increases the risk of CIED infection. Precaution should be taken during device implantation to reduce postimplantation hematoma and subsequent CIED infection.

Risk Factors for Mortality in Cardiac Implantable Electronic Device (CIED) Infections: A Systematic Review and Meta-Analysis

“…Several studies have identified risk factors for the development of CIED infections, for example, older age, end-stage kidney disease, and poorly controlled diabetes mellitus [ 9 ]. In addition, peri-implant complications, such as pocket hematoma requiring repeat intervention have also been associated with higher rates of device infection [ 10 , 11 ].…”

Extra-articular bloody tophi in pacemaker pocket: A case report

“…Hematoma is among the most common complications, occurring in up to 3% of pacemaker cases and increasing the risk of other adverse effects, 2 including pacemaker infection. 3 The use of anticoagulation therapy further elevates the risk of hematoma following pacemaker or intracardiac defibrillator procedures. 1 , 4 Additionally, patients who experience hematoma complications have a slightly higher in-hospital mortality rate (1.3%) and incur significantly increased hospital costs of over $14,000 (US dollars).…”

Cardiac Implantable Electronic Devices Infection Assessment, Diagnosis and Management: A Review of the Literature

“…Pocket hematoma that complicates CIEDs placement or invasive manipulation has been identified as a risk factor for infection [ 79 ]. Prevention of hematoma during the procedure is desirable: meticulous cautery of bleeding sites, application of topical thrombin, irrigation of the pocket, the use of monofilament suture for sub-cuticular layer, a pressure dressing applied for 12 to 24 h after skin closure may decrease the risk of hematoma formation [ 49 ].…”