Abstract 9338: In-hospital Complications During 35747 Permanent Pacemaker Implantations from 2009-2018: A Statewide Australian Cohort Study

Abstract

Background: Permanent pacemaker implantation (PPI) is standard of care for significant bradyarrhythmia since the early 1960’s. Understanding its utilisation and projection in our ageing populations has important implications on medical resource utilisation. This study reports the rates of PPI in the state of New South Wales (NSW), Australia from 2009-2018. Hypothesis: We hypothesized PPI in patients ≥80yrs has increased faster than in <80yrs over past decade. Methods: We examined the prevalence of PPI from Jan 2009 to Dec 2018 by extracting administrative details of all permanent pacemakers implanted statewide, including patient’s characteristics and in-hospital complications using the NSW Centre-for-Health-Record-Linkage datasets. All analysis was stratified by age <80yrs vs ≥80yrs old. Results: A total of 35747 admissions involved PPI (60% males) during the study period. The mean ±SD implantation rate and age was 3574±311 PPI per annum and 78±10yrs respectively. 18187 (50.9%) of PPI were in patients ≥80yrs. The mean annual rate of PPI was 593.4±57.6 per 100000 persons for ≥80yrs, compared to 24.5±2.1 per 100000 persons in <80yrs (p=0.0001). The overall mean rate of increase in PPI from 2009-2018 for ≥80yrs old was 2.6±3.7% compared to 1.7±3.2% per annum in <80yrs (p=0.001). The median (interquartile range [IQR]) length of stay (LOS) in patients ≥80yrs requiring emergency PPI was 8 (5-14) days, compared to 1 (1-3) days in those who had an elective PPI procedure, p<0.05. For patients <80yrs old, the median (IQR) LOS was 7 (4-12) days compared to 1 (1- 2) days, p<0.05 respectively. Overall, complications of pacemaker implantation excluding death was 8%. Although overall in-hospital mortality was low, it was higher for patients ≥80yrs compared to the <80yrs group (0.9% vs 0.6%; p<0.001). Overall complication rates declined only in last two years of the study period, with no significant change for in hospital death. Conclusion: Overall PPI increased between 2009-2018, with the increase greatest in patients ≥80yrs. Overall complication rates remained elevated, with in-hospital mortality higher in the older group. Future studies should examine strategies that reduce in-hospital complications during pacemaker implantations.