Economic implications of infections of implantable cardiac devices in a single institution.

Introduction: The use of medical devices, such as cardiac pacemakers, prosthetic heart valves and vascular prostheses, has become a routine treatment procedure in cardiovascular medicine. Unfortunately, bacterial infections of these devices are a serious and sometimes life-threatening for the patient, necessitating explantation. Despite implementing different prophylactic strategies to avoid contamination of the device, infections do occur. This study analysed the additional hospital costs associated with managing cardiac device infections, with special focus on cardiac pacemakers/defibrillators, prosthetic heart valves and vascular prostheses.

Methods: Out of more than 2000 operations performed in our institution in 2006, we had 462 implantations/replacements of cardiac pacemakers/implantable cardioverter defibrillators (ICDs), 577 valve replacement procedures and 613 vascular operations. Among these, we analysed all patients who received operations because of an infection of their cardiac or vascular device. Our investigations focussed on standard parameters regarding additional hospital costs, including length of stay in hospital, required time in the operating room and time in the intensive care unit.

Results: In 2006, we had nine cases (n=9) of prosthetic valve endocarditis in our hospital. The average length of stay in hospital for these patients was 25 days, resulting in euro72096 of additional hospital costs per case. Infection of vascular prostheses (n=6) leads to euro35506 per case and 28 days in the hospital. If an infection of cardiac pacemakers (n=7) does occur, the therapy causes a mean additional hospital cost of euro7091.

Conclusion: Cardiac device infections are serious and sometimes life-threatening. Therapy and eradication are difficult and protracted and cause high additional hospital costs. Based on our statistical data and the mean incidence of cardiac device infections, we presume for Germany between euro38 and euro140 million in additional hospital costs per year are incurred by infections of implantable cardiovascular devices. Active surveillance and establishment of a central register with documentation of every implantation and the occurrence of any infection can only realise detailed estimates of the economic damage caused by infection of cardiovascular implants. In consideration of the economic consequences, successful strategies must be developed to reduce the incidence of infections.