S1028 The Clinical Impact of Cirrhosis on the Postprocedural Outcomes of Patients Undergoing Intracardiac Device Insertion

INTRODUCTION: Patients with cirrhosis are at potential risk of developing postoperative complications following intracardiac device insertion (IDI) due to liver-related immune dysfunction and poor wound-healing. In this study, we evaluate effects of cirrhosis on the postprocedural outcomes of patients undergoing IDI. METHODS: Patients who underwent IDI with intracardiac defibrillators or pacemakers were selected from the 2011–2017 National Inpatient Sample and were further stratified by the presence of cirrhosis. The study endpoints included mortality, length of stay (LOS), hospitalization costs, postoperative complications. A subgroup analysis evaluated the effects of decompensated cirrhosis (defined by the presence of ascites, variceal bleeding, hepatorenal syndrome, hepatic encephalopathy, and/or SBP) on the study endpoints. RESULTS: Of the 259424 patients who had an IDI, 2288 (0.88%) patients had cirrhosis. Compared to the control cohort, the cirrhosis cohort was younger (67 vs 72.6y P < 0.01) and more likely to be male (65.7 vs 55.4% P < 0.01). The mortality was higher in the cirrhosis cohort (5.11 vs 2.45% P < 0.01, OR 2.14 95%CI 1.78–2.59), as were the LOS (9.96 vs 6.4d P < 0.01) and hospitalization costs ($175,557 vs $128,101 P < 0.01). In terms of postoperative complications, the cirrhosis cohort had higher rates of device infection (1.97 vs 1.39% P = 0.02, OR 1.42 95%CI 1.06–1.92), bleeding complications (3.54 vs 1.70% P < 0.01, OR 2.13 95%CI 1.7–2.66), wound complications (0.66 vs 0.30% P < 0.01, OR 2.21 95%CI 1.32–3.68), but no difference was found in mechanical complications (5.64 vs 5% P = 0.18, OR 1.14 95%CI 0.95–1.36). In a multivariate model, the presence of cirrhosis was associated with increased mortality (P = 0.03, aOR 1.30 95%CI 1.02–1.64). In a cirrhosis subgroup analysis, the presence of hepatic decompensation was associated with higher mortality (8.83 vs 3.83% P < 0.01, OR 2.43 95%CI 1.67–3.55) but was not associated with increased postoperative complications (device infection: 1.53 vs 2.12% P = 0.47, OR 0.72 95%CI 0.34–1.5; bleeding complication: 3.74 vs 3.47% P = 0.87, OR 1.08 95%CI 0.65–1.78; wound complication 0.68 vs 0.65% P = 1, OR 1.05 95%CI 0.24–3.56; mechanical complication: 5.77 vs 5.59% P = 0.95, OR 1.03 95%CI 0.69–1.55). CONCLUSION: The presence of cirrhosis is associated with increased postprocedural mortality in patients undergoing IDI. These patients therefore require early risk-assessment, followed by multidisciplinary management of postprocedural and liver-related complications.Figure 1.: Multivariate model: cirrhosis is associated with increased postprocedural mortality in patients undergoing intracardiac device insertion.