Abstract
Permanent pacemaker implantation is increasing exponentially to treat atrio-ventricular blockade, symptomatic bradyarrhythmia. Despite being a minor surgery, immediate complication such as pocket infection, pocket hematoma, pneumothorax, hemopericardium, lead displacement does occur. Aim of the study is to determine co-morbidities and complication rate in patients ≤ 70 years (younger) and > 70 years (elderly) with permanent pacemaker. The Nationwide Inpatient Sample was queried from 2016 to 2018 to identify patients with pacemaker using ICD-10 procedure code. Chi- square test were used for statistical analysis. The sample size consisted of 436805 patients with pacemaker, 28% were ≤ 70 years (male 57%, mean age 60.59 ± 9.7, Caucasian 70%) and 72% were > 70 years (male 50%, mean age 81.4 ± 5.9, Caucasian 79%). Upon comparison of rates in younger vs elderly, mortality was (1.5 % vs 1.5 %, p < 0.001), AKI (16.5 % vs 21.2%; p <0.001), obesity (25.9 % vs 12.4 %, p <0.001), coronary artery disease (40.8% vs 49.2%; p <0.001), peripheral artery disease (1.7% vs 3.1%; p <0.001), CHF (31.2% vs 39%; p<0.001), diabetes (31.5% vs 27.1%; p<0.001), vascular complications (1.1% vs 1.2%;p =0.006), pocket hematoma (0.5% vs 0.8%; p<0.001), hemopericardium (0.1% vs 0.1%;p=0.23), hemothorax (0.3% vs 0.2%;p <0.001), cardiac tamponade (0.4% vs 0.5%; p<0.023), pericardiocentesis (0.4% vs 0.4%; p<0.023, cardiogenic shock (3.8% vs 2.3%;p<0.001), respiratory complications (1.9% vs 0.9%; p<0.001), mechanical ventilation (5.0% vs 2.9%; p<0.001); post-op bleed (0.5% vs 0.3%; p<0.001), anemia (39% vs 49% p<0.001), need for transfusion (4.7% vs 3.8%; p <0.001), ischemic stroke (0.8% vs 0.9%; p 0.043), atrial fibrillation (35% vs 49%; p <0.001), severe sepsis (0.6% vs 0.5%; p <0.001 ), septic shock (2% vs 1%;p <0.001 ), bacteremia (0.7% vs 0.3%; p <0.001), lead dislodgement (1.4% vs 1.1%; p< 0.001). Our study found that overall complication rate was lower in the elderly despite higher co-morbidities. This is similar to previous studies where the rates were lower in the elderly. Hence guideline driven pacemaker placement in elderly should be performed especially in patients with good life expectancy.
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