Institutional Variation in Quality of Cardiovascular Implantable Electronic Device Implantation: A Cohort Study.

<bold>Background: </bold>Cardiovascular implantable electronic devices (CIEDs) are associated with procedure-related complications, yet little is known about variation in complication rates among institutions that may suggest disparities in care quality.<bold>Objective: </bold>To assess institutional variation in risk-standardized complication rates (RSCRs) for CIED.<bold>Design: </bold>Cohort study.<bold>Setting: </bold>174 hospitals in Australia and New Zealand, 98 of which implanted at least 25 CIEDs during the study period.<bold>Participants: </bold>81 304 patients older than 18 years (mean, 74.7 years [SD, 12.4]; 37.9% female) who received a new CIED (65 711 permanent pacemakers [PPMs] and 15 593 implantable cardioverter-defibrillators [ICDs]) in 2010 to 2015.<bold>Measurements: </bold>RSCRs and frequencies of major device-related complications during hospitalization or within 90 days of discharge.<bold>Results: </bold>Of the cohort, 6664 patients (8.2%) had a major complication. Although complication rates were higher for ICDs than PPMs (10.04% vs. 7.76%), 76.5% of all complications were attributable to PPMs (5098 vs. 1566 for ICDs). Among hospitals that implanted at least 25 CIEDs, the median RSCR was 8.1%; however, rates varied from 5.3% to 14.3%, with 22 hospitals identified as having RSCRs that differed significantly from the national average. Similar variation was observed when RSCRs for PPM implantation (n = 96 hospitals) (median RSCR, 7.6% [range, 5.4% to 12.9%]) were considered separately from those for ICD placement (n = 68 hospitals) (median RSCR, 9.7% [range, 6.2% to 16.9%]) and persisted when only elective procedures were assessed (n = 88 hospitals) (median RSCR, 7.4% [range, 4.7% to 13.0%]).<bold>Limitation: </bold>Possible unmeasured confounding from the use of administrative data.<bold>Conclusion: </bold>CIED complications are common and vary among hospitals, suggesting institutional variation in CIED care quality. Concerted clinical and policy interventions are needed to address CIED-related complications. These efforts should preferentially target PPMs, because most CIED complications are attributable to these devices.<bold>Primary Funding Source: </bold>The Hospitals Contribution Fund Research Foundation. [ABSTRACT FROM AUTHOR]