P256 - EVALUATING SHORT-TERM RISK FACTORS FOR CARDIAC DEVICE-RELATED INFECTIONS BASED ON PATIENT DEMOGRAPHICS, COMORBIDITIES, DEVICE TYPE, AND PROCEDURAL SETTINGS

Background: Cardiac Implantable Electronic Devices, including pacemakers, implantable cardiac defibrillators and cardiac resynchronization therapy systems, are important therapeutic options with growing utilization, especially among the aging population. However, cardiac device-related infections (CDRI) remains a significant clinical concern, contributing to elevated mortality and morbidity. This study aims to evaluate the association between 30-day readmission for CDRI and patient demographics, preoperative comorbidities, and procedural characteristics.

METHODS AND RESULTS: We conducted a retrospective study from May 2019 to April 2024 across 15 Hospital Corporation of America facilities located in western Florida. Using Current Procedural Terminology codes, we identified an initial cohort of 10,022 patients who underwent device implantation, removal, generator replacement, lead revision, or pocket revision. Patients readmitted within 30 days with a diagnosis of CDRI were re-identified, yielding a study population of 2,306 individuals. Patient demographics, preoperative comorbidities, and procedural factors were compared between those readmitted with CDRI and those without readmission.

The highest rate of readmission was observed in patients undergoing lead insertion (81.2%, n=1,872), followed by lead removal (10.4%, n=239), lead replacement (4.4%, n=102), lead revision (3.6%, n=83), and pocket manipulation (0.4%, n=10). Multivariable regression analysis identified several factors significantly associated with increased risk of CDRI-related readmission: history of chronic obstructive pulmonary disease (OR 1.17, 95% CI 1.03–1.33), chronic kidney disease (OR 1.29, 95% CI 1.14–1.45), and heart failure (OR 1.39, 95% CI 1.25–1.55). Patients with permanent pacemakers had higher odds of readmission compared to those with automatic implantable cardioverter- defibrillators (OR 1.29, 95% CI 1.08–1.53). Additionally, readmissions were more likely in patients with surgical field complications (OR 1.90, 95% CI 1.33–2.71) than in those with purely cardiological issues. Use of steroid therapy (OR 1.35, 95% CI 1.05–1.74) and prolonged hospital stay (OR 1.03, 95% CI 1.02–1.03) were also significantly associated with increased readmission risk.

Conclusion: Our findings highlight a range of clinical and procedural risk factors associated with readmission due to CDRI. Recognition of these predictors may aid cardiologists in risk stratification and inform post-implantation management strategies to reduce readmission rates following cardiac electronic device implantation.