Intraoperative Complications/mortality

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Editorial

Unscheduled Return Visits to the Emergency Department after Cardiac Electronic Devices Implantation

In recent years, many initiatives have been made to improve the quality and efficiency of healthcare services leading to the creation and standardization of health quality indicators in order to improve the interaction between clinicians, researchers, and healthcare managers, enabling the generation of evidence-based strategies. In this context, the rate of hospital readmissions is one of the most important indicators to measure the quality of healthcare services.

The use of quality indicators to measure healthcare performance across different hospitals has been considered of great value for the improvement of healthcare routines, enhancing the expenditure rationalization of health services. In this scenario, the adoption of the International Consortium for Health Outcomes Measurement (ICHOM) as a strategy to measure outcomes across hospitals has increased worldwide and it is now gaining familiarity among Brazilian hospitals.

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Original Article

Complications after Surgical Procedures in Patients with Cardiac Implantable Electronic Devices: Results of a Prospective Registry

Katia Regina da Silva et al. Caio Marcos de Moraes Albertini Elizabeth Sartori Crevelari Eduardo Infante Januzzi de Carvalho … Alfredo Inácio Fiorelli Martino Martinelli Filho Roberto Costa

Abstract

Background:

Complications after surgical procedures in patients with cardiac implantable electronic devices (CIED) are an emerging problem due to an increasing number of such procedures and aging of the population, which consequently increases the frequency of comorbidities.

Objective:

To identify the rates of postoperative complications, mortality, and hospital readmissions, and evaluate the risk factors for the occurrence of these events.

Methods:

Prospective and unicentric study that included all individuals undergoing CIED surgical procedures from February to August 2011. The patients were distributed by type of procedure into the following groups: initial implantations (cohort 1), generator exchange (cohort 2), and lead-related procedures (cohort 3). The outcomes were evaluated by an independent committee. Univariate and multivariate analyses assessed the risk factors, and the Kaplan-Meier method was used for survival analysis.

Results:

A total of 713 patients were included in the study and distributed as follows: 333 in cohort 1, 304 in cohort 2, and 76 in cohort 3. Postoperative complications were detected in 7.5%, 1.6%, and 11.8% of the patients in cohorts 1, 2, and 3, respectively (p = 0.014). During a 6-month follow-up, there were 58 (8.1%) deaths and 75 (10.5%) hospital readmissions. Predictors of hospital readmission included the use of implantable cardioverter-defibrillators (odds ratio [OR] = 4.2), functional class III-IV (OR = 1.8), and warfarin administration (OR = 1.9). Predictors of mortality included age over 80 years (OR = 2.4), ventricular dysfunction (OR = 2.2), functional class III-IV (OR = 3.3), and warfarin administration (OR = 2.3).

Conclusions:

Postoperative complications, hospital readmissions, and deaths occurred frequently and were strongly related to the type of procedure performed, type of CIED, and severity of the patient’s underlying heart disease.