Predictors of Intensive Care Unit Admission in Patients Undergoing Lead Extraction: A 10-Year Observational Study in a High-Volume Center

Fabrizio Monaco, Nora Di Tomasso, Giovanni Landoni, Pasquale Nardelli, Andrea Radinovic, Francesco Melillo, Giuseppe D'Angelo, Paolo Della Bella, Alberto Zangrillo, Patrizio Mazzone

Research output: Contribution to journalArticle

Abstract

Objective: To identify reliable predictors of periprocedural intensive care unit (ICU) admission after transvenous lead extraction (LE) in a high-volume center. Design: Retrospective observational study. Setting: University tertiary-care hospital. Participants: All patients undergoing LE at San Raffaele Scientific Institute, Milan, Italy, from 2005 to 2015. Interventions: LE procedures were performed in the electrophysiology laboratories with a cardiac operating room on standby between the end of the morning surgical case and before the start of the afternoon surgical case. Most procedures were conducted with the patient under procedural sedation and analgesia. After LE, patients were admitted either to the ward or to the ICU. Medical history and intraprocedural data were recorded. Measurements and Main Results: Of the 389 procedures performed during the study period, 50 patients (13%) were admitted to the ICU owing to persistent hemodynamic instability or intraoperative complications requiring endotracheal intubation. Complete procedural success was achieved in 370 patients (95%), and the clinical success rate was 98.4%. No deaths were recorded. Five complications requiring emergency surgery (1.3%) were reported. Preprocedural right ventricular dysfunction (odds ratio (OR) 7.41; confidence interval 1.85-29.7; p < 0.01) and the need for general anesthesia (OR 12; confidence interval 1.49-97.06; p = 0.019) were independent predictors of ICU admission. Conclusions: Preoperative identification of patients who need ICU admission after LE is crucial to increase patient safety and decrease hospital costs. Severe right ventricular dysfunction and need for general anesthesia identify patients with low cardiac reserve who are at increased risk for ICU admission after the procedure.

Original languageEnglish
Pages (from-to)1845-1851
Number of pages7
JournalJournal of Cardiothoracic and Vascular Anesthesia
Volume33
Issue number7
DOIs
Publication statusPublished - Jul 2019

Keywords

  • cardiac implantable electronic devices
  • general anesthesia
  • intensive care unit
  • lead extraction
  • mortality
  • procedural sedation and analgesia

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Anesthesiology and Pain Medicine

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