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Published on: July 13, 2019
The effect of a standardised protocol for CIED insertion on complications and infection rates in a DGH
Eliza Foster1, Guy Furniss2, Mark Dayer2
1Cardiac Healthcare Scientist Bristol Heart Institute, Terrell Street, Bristol, BS2 8ED.
Insights
Implementing a new protocol for cardiac implantable electronic device (CIED) insertion significantly reduced overall complications. While CIED infections also decreased, the reduction did not reach statistical significance.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Device Technology
Background:
- Cardiac implantable electronic device (CIED) complications and infections can lead to extended hospital stays and mortality.
- Standardized protocols are crucial for minimizing risks associated with CIED procedures.
Purpose of the Study:
- To evaluate the impact of a new CIED insertion protocol on complication and infection rates.
- To determine if the new protocol led to a statistically significant reduction in adverse events.
Main Methods:
- A retrospective review of medical records for CIED insertions before and after protocol implementation.
- Analysis of complication and infection rates over a one-year follow-up period post-insertion.
- Comparison of device complexity and patient outcomes between the two periods.
Main Results:
- A significant reduction in overall CIED-related complications was observed, decreasing from 6.86% to 3.95% (p<0.0001).
- CIED-related infections decreased from 1.6% (14/871) pre-protocol to 0.44% (4/683) post-protocol.
- The reduction in infection rates did not achieve statistical significance (p=0.093).
Conclusions:
- The standardized CIED insertion protocol effectively reduced the overall rate of complications.
- While the protocol showed a trend towards reduced infection rates, further investigation may be needed to confirm statistical significance.
Abstract:
Cardiac implantable electronic device (CIED)-related complications and infections typically lead to prolonged hospital stays and, very occasionally, death. A new CIED insertion protocol was implemented in a district general hospital. The primary objective of this study was to determine whether a significant reduction in complication and infection rates occurred after implementation of the new protocol. Medical records were reviewed for patients who had a CIED inserted in the two years pre- and post-protocol implementation, and any complications were identified in a one-year follow-up period. An increase in the complexity of the devices implanted after introduction of the protocol was observed. The number of complications was significantly reduced from 6.86% to 3.95% (p<0.0001). In the two years prior to protocol implementation, 14 of 871 (1.6%) patients suffered a CIED-related infection. In contrast, four of 683 (0.44%) patients suffered a CIEDrelated infection in the two years postimplementation. This was not statistically significant (p=0.093). In conclusion, implementing a standardised protocol for CIED insertion significantly reduced the rate of complications, and also reduced the rate of infection, but this was not statistically significant.
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