Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries
Background The presence of permanent pacemakers (PPM) is common among the elderly population. Trauma literature has shown that the inability to augment cardiac output by at least 30% after injury portends a higher mortality. The presence of a PPM may be a surrogate marker to identify patients who ar...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-11-01
|
| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/8/1/e001053.full |
| _version_ | 1797367203637493760 |
|---|---|
| author | Tanzim Bhuiya Demian Omeh Rezwan Munshi Brian Berookhim Ashley Roper Viliane Vilcant Elisa Syzdziak Ofek Hai Roman Zeltser Jody Digiacomo Amgad N Makaryus |
| author_facet | Tanzim Bhuiya Demian Omeh Rezwan Munshi Brian Berookhim Ashley Roper Viliane Vilcant Elisa Syzdziak Ofek Hai Roman Zeltser Jody Digiacomo Amgad N Makaryus |
| author_sort | Tanzim Bhuiya |
| collection | DOAJ |
| description | Background The presence of permanent pacemakers (PPM) is common among the elderly population. Trauma literature has shown that the inability to augment cardiac output by at least 30% after injury portends a higher mortality. The presence of a PPM may be a surrogate marker to identify patients who are unable to increase cardiac output. We aimed to evaluate the association between the presence of PPM and clinical outcomes in elderly patients presenting with traumatic injuries.Methods A total of 4505 patients aged ≥65 years admitted with acute trauma from 2009 to 2019 at our Level I Trauma center were evaluated and stratified into two groups using propensity matching on age, sex, injury severity score (ISS), and year of admission based on the presence of PPM. Logistic regression was performed to analyze the impact of the presence of PPM on mortality, surgical intensive care unit (SICU) admission, operative intervention, and length of stay. Prevalence of cardiovascular comorbidities was compared using χ2 analysis.Results Data from 208 patients with PPM and 208 propensity-matched controls were evaluated. Charlson Comorbidity Index, mechanism of injury, intensive care unit admission, and rate of operative intervention were comparable in the two groups. PPM patients had more coronary artery disease (p=0.04), heart failure with reduced ejection fraction (p=0.003), atrial fibrillation (AF, p<0.0001), and antithrombotic use (p<0.0001). We found no association between mortality amongst the groups after controlling for influencing variables (OR=2.1 (0.97 to 4.74), p=0.061). Patient characteristics associated with survival included female sex (p=0.009), lower ISS (p<0.0001), lower revised trauma score (p<0.0001), and lower SICU admission (p=0.001).Conclusion Our study shows no association between mortality among patients with PPM admitted for treatment of trauma. Presence of a PPM may be an indicator of cardiovascular disease, but this does not translate into increased risk in the modern era of trauma management in our patient population.Level of evidence Level III. |
| first_indexed | 2024-03-08T17:14:52Z |
| format | Article |
| id | doaj.art-7249e5019c89470d9e3dd74785efb67c |
| institution | Directory Open Access Journal |
| issn | 2397-5776 |
| language | English |
| last_indexed | 2024-03-08T17:14:52Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj.art-7249e5019c89470d9e3dd74785efb67c2024-01-03T14:40:08ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762023-11-018110.1136/tsaco-2022-001053Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic InjuriesTanzim Bhuiya0Demian Omeh1Rezwan Munshi2Brian Berookhim3Ashley Roper4Viliane Vilcant5Elisa Syzdziak6Ofek Hai7Roman Zeltser8Jody Digiacomo9Amgad N Makaryus10Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USACardiology, Nassau University Medical Center, East Meadow, New York, USACardiology, Nassau University Medical Center, East Meadow, New York, USACardiology, Nassau University Medical Center, East Meadow, New York, USACardiology, Nassau University Medical Center, East Meadow, New York, USACardiology, Nassau University Medical Center, East Meadow, New York, USASurgery, Nassau University Medical Center, East Meadow, New York, USACardiology, Nassau University Medical Center, East Meadow, New York, USADonald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USASurgery, Nassau University Medical Center, East Meadow, New York, USADonald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USABackground The presence of permanent pacemakers (PPM) is common among the elderly population. Trauma literature has shown that the inability to augment cardiac output by at least 30% after injury portends a higher mortality. The presence of a PPM may be a surrogate marker to identify patients who are unable to increase cardiac output. We aimed to evaluate the association between the presence of PPM and clinical outcomes in elderly patients presenting with traumatic injuries.Methods A total of 4505 patients aged ≥65 years admitted with acute trauma from 2009 to 2019 at our Level I Trauma center were evaluated and stratified into two groups using propensity matching on age, sex, injury severity score (ISS), and year of admission based on the presence of PPM. Logistic regression was performed to analyze the impact of the presence of PPM on mortality, surgical intensive care unit (SICU) admission, operative intervention, and length of stay. Prevalence of cardiovascular comorbidities was compared using χ2 analysis.Results Data from 208 patients with PPM and 208 propensity-matched controls were evaluated. Charlson Comorbidity Index, mechanism of injury, intensive care unit admission, and rate of operative intervention were comparable in the two groups. PPM patients had more coronary artery disease (p=0.04), heart failure with reduced ejection fraction (p=0.003), atrial fibrillation (AF, p<0.0001), and antithrombotic use (p<0.0001). We found no association between mortality amongst the groups after controlling for influencing variables (OR=2.1 (0.97 to 4.74), p=0.061). Patient characteristics associated with survival included female sex (p=0.009), lower ISS (p<0.0001), lower revised trauma score (p<0.0001), and lower SICU admission (p=0.001).Conclusion Our study shows no association between mortality among patients with PPM admitted for treatment of trauma. Presence of a PPM may be an indicator of cardiovascular disease, but this does not translate into increased risk in the modern era of trauma management in our patient population.Level of evidence Level III.https://tsaco.bmj.com/content/8/1/e001053.full |
| spellingShingle | Tanzim Bhuiya Demian Omeh Rezwan Munshi Brian Berookhim Ashley Roper Viliane Vilcant Elisa Syzdziak Ofek Hai Roman Zeltser Jody Digiacomo Amgad N Makaryus Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries Trauma Surgery & Acute Care Open |
| title | Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries |
| title_full | Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries |
| title_fullStr | Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries |
| title_full_unstemmed | Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries |
| title_short | Presence of Permanent Pacemakers: Implications for Elderly Patients Presenting with Traumatic Injuries |
| title_sort | presence of permanent pacemakers implications for elderly patients presenting with traumatic injuries |
| url | https://tsaco.bmj.com/content/8/1/e001053.full |
| work_keys_str_mv | AT tanzimbhuiya presenceofpermanentpacemakersimplicationsforelderlypatientspresentingwithtraumaticinjuries AT demianomeh presenceofpermanentpacemakersimplicationsforelderlypatientspresentingwithtraumaticinjuries AT rezwanmunshi presenceofpermanentpacemakersimplicationsforelderlypatientspresentingwithtraumaticinjuries AT brianberookhim presenceofpermanentpacemakersimplicationsforelderlypatientspresentingwithtraumaticinjuries AT ashleyroper presenceofpermanentpacemakersimplicationsforelderlypatientspresentingwithtraumaticinjuries AT vilianevilcant presenceofpermanentpacemakersimplicationsforelderlypatientspresentingwithtraumaticinjuries AT elisasyzdziak presenceofpermanentpacemakersimplicationsforelderlypatientspresentingwithtraumaticinjuries AT ofekhai presenceofpermanentpacemakersimplicationsforelderlypatientspresentingwithtraumaticinjuries AT romanzeltser presenceofpermanentpacemakersimplicationsforelderlypatientspresentingwithtraumaticinjuries AT jodydigiacomo presenceofpermanentpacemakersimplicationsforelderlypatientspresentingwithtraumaticinjuries AT amgadnmakaryus presenceofpermanentpacemakersimplicationsforelderlypatientspresentingwithtraumaticinjuries |