Thirty-day readmissions after cardiac implantable electronic devices in the United States: Insights from the Nationwide Readmissions Database

Background: Limited data are available regarding true estimates of individual complications contributing to readmissions after cardiac implantable electronic device (CIED) implantation. Objective: The purpose of this study was to identify predictors of 30-day readmission in patients admitted for CIED implantation. Methods: The study cohort consisted of patients who underwent CIED implantation in 2014, identified from the National Readmission Database. Readmission was defined as a subsequent hospital admission within 30 days after the discharge day of index admission. If patients had more than 1 readmission within 30 days, only the first readmission was included. Results: Our final cohort consisted of 70,223 cases, 61,738 (88%) in the no-readmission group and 8485 patients (12%) in the readmission group. Female gender (odds ratio [OR] 1.09; 95% confidence interval [CI] 1.04–1.14; P =.001), atrial fibrillation/flutter (OR 1.23; 95% CI 1.17–1.29, P <.001), acute renal failure (OR 1.65; 95% CI 1.56–1.74; P <.001), coronary artery disease (OR 1.09; 95% CI 1.03–1.14; P =.002), length of stay (OR 1.70; 95% CI 1.51–1.89; P <.001), device placement on the day of admission (OR 0.87; 95% CI 0.80–0.95, P =.001), and fourth quartile of hospital procedure volume (OR 0.91; 95% CI 0.84–0.99; P =.03; first quartile of hospital procedure volume as reference) were independent predictors of 30-day readmissions. The 30-day readmission resulted in additional median charges of $30,692 per patient. Device-related complications were seen in 10.7% of readmitted patients. The most common complications were mechanical (2.8%) and infectious (2.6%). Conclusion: Several patient and hospital-related factors were identified to be independent predictors of 30-day readmission, accounting for increased health care cost.