Sex differences in outcomes of transvenous lead extraction: insights from National Readmission Database

Background With the growing use of implantable cardiac devices, the need for transvenous lead extraction has increased, which translates to increased procedural volumes. Sex differences in lead extraction outcomes are not well studied. Objective The present study aims at evaluating the impact of sex on outcomes of lead extraction. Methods We identified 71,754 patients who presented between 2016 and 2019 and underwent transvenous lead extraction. Their clinical data were retrospectively accrued from the National Readmission Database (NRD) using the corresponding diagnosis codes. We compared clinical outcomes between male and female patients. Odds ratios (ORs) for the primary and secondary outcomes were calculated, and multivariable regression analysis was utilized to adjust for confounding variables. Results Compared to male patients, female patients had higher in-hospital complications including pneumothorax (OR 1.26, 95% CI (1.07–1.4), P < 0.01), hemopericardium (OR 1.39, 95% CI (1.02–1.88), P = 0.036), injury to superior vena cava and innominate vein requiring repair (OR 1.88, 95% CI (1.14–3.1), P = 0.014; OR 3.4, 95% CI (1.8–6.5), P < 0.01), need for blood transfusion (OR 1.28, 95% CI (1.18–1.38), P < 0.01), and pericardiocentesis (OR 1.6, 95% CI (1.3–2), P < 0.01). Thirty-day readmission was also significantly higher in female patients (OR 1.09, 95% CI (1.02–1.17), P < 0.01 ). There was no significant difference regarding in-hospital mortality (OR 0.99, 95% CI (0.87–1.14), P = 0.95 ). Conclusion In female patients, lead extraction is associated with worse clinical outcomes and higher 30-day readmission rate.