Device Pocket Hematoma Formation: A Real-World Analysis
Journal of the American College of Cardiology
Background: Device pocket hematoma (DPH) continues to be a significant postoperative complication of cardiac implantable electronic device (CIED) procedures. Infection, the most detrimental effect of a pocket hematoma, has been shown to increase morbidity and mortality. We explore risk factors for device-pocket hematomas in a real-world scenario. Methods: We used the Premier dataset from 01/2011 - 09/2015. ICD Ninth Revision (ICD-9) procedure and diagnosis codes were used to determine pacemaker implantation procedure and hematoma formation for an inpatient visit or readmittance to the same hospital. Multivariable logistic regression was used to identify significant predictors of pocket hematoma. Results: Of the 181,853 inpatients in our dataset who underwent initial insertion or replacement pacemaker implantation, the pocket hematoma incidence was 185 per 10,000 pacemakers. Incidence of hematoma significantly increased the mean total hospital cost ($50,595.09 vs. $22,768.94, P<0.001) and mean length of stay (12.26 vs. 5.83 days, P<0.0001). Multivariable logistic regression identified atrial fibrillation (OR: 1.37; 95% CI: 1.28-1.47), congestive heart failure (CHF) (OR: 1.38; 95% CI: 1.28-1.49), chronic kidney disease (OR: 1.17; 95% CI: 1.08- 1.26) and coronary artery disease (CAD) (OR: 1.59; 95% CI: 1.48-1.71) as statistically significant predictors of DPH formation. Conclusion: In this retrospective database analysis of patients undergoing pacemaker implantation, DPH was found to be a profound complication for the patient and the healthcare system. Cardiovascular comorbidities such as atrial fibrillation, CHF, and CAD were associated with a significant increase in pocket hematoma risk.
Peters G, France J, Mazimba S, Deshmukh A, Dani SS, Mehta N. Device pocket hematoma formation: a real-world analysis. J Am Coll Cardiol. 2023 Mar;81(8 Suppl.A):112. doi:10.1016/S0735-1097(23)00556-9