| Aims: POF(Postoperative fever)is a common phenomenon after TLE(transvenous lead extraction)from cardiovascular implantable electronic device pocket infection.In this study,we compared the medical records of patients with fever and patients without fever,to explore the risk factors,etiology and characteristics of postoperative fever,and to explore the effectiveness and safety of transvenous lead extraction from cardiovascular implantable electronic device pocket infection.Methods: From October 2011 to March 2019,patients with cardiovascular implantable electronic devices related isolated pocket infection who underwent transvenous lead extraction were consecutively selected from the Department of cardiovascular medicine of Nanjing Drum Tower Hospital.The basic data,associated diseases,implanted electronic devices,surgical characteristics of transvenous lead extraction,complications,operation efficiency,length of stay and hospitalization expenses were collected.For patients with postoperative temperature above 38℃,the fever peak,duration,laboratory examination and etiology were collected,and the risk factors of postoperative fever and the incidence and relevant characteristics of fever caused by various etiologies were analyzed.By comparing the basic data and operative data of patients with and without operative complications,the possible factors of operative complications were discussed.Results: A total of 269 patients were selected,of which 44 patients had POF.The number of leads extracted(P=0.014,OR=2.549,95%CI:1.209-5.375),categories of tools(P=0.049,OR=1.799,95%CI:1.004-3.225),and complications(P=0.018,OR=4.551,95%CI: 1.301-15.912)were independent risk factors for POF following TLE in patients with pocket infection.24patients(30%)were diagnosed as infectious fever and 20 patients with antibiotic related fever accounted for 45% of fever patients.Compared with infectious fever,antibiotic related fever was longer than surgery(7.5day VS 2 day;P=0.001)and has higher fever peak(39℃ VS 38℃;P<0.001)and longer duration(4 day VS 1 day;P < 0.001).The difference of leukocyte count[(-1.44±1.11)x10^9/L VS(3.96±2.43)x10^9/L;P<0.001],neutrophil count[(-1.16±1.11)x10^9/L VS(3.72±2.25)x10^9/L;P<0.001],monocyte count(0.01±0.17 VS 0.51±0.22;P<0.001)and eosinophil count[(0.09±0.12)x10^9/L VS(-0.07±0.13)x10^9/L;P=0.001] between antibiotic related drug fever and infectious fever were statistically significant.The length of stay in hospital of febrile patients was longer than that of non febrile patients(22.89±7.75 day VS 17.95±6.59 day;P<0.001);The hospitalization cost of febrile patients is higher than that of non febrile patients(12.49±5.71 ten thousand VS 9.81±5.22 ten thousand;P=0.007).Conclusions:1.POF was a common phenomenon following TLE in patients with pocket infection and it could prolong the length of stay and increase the cost of hospitalization.The number of leads extracted,categories of tools and mild complications were independent risk factors.2.The infectious fever following TLE in patients with pocket infection mainly occurred 0 to 4 days after TLE.The peak of infectious fever was low,the duration was short.The etiology was usually considered to be caused by transient bacteremia during operation,which suggested that the use of antibiotic load before operation was particularly important.3.The drug fever caused by glycopeptide antibiotics following TLE in patients with pocket infection was worthy of attention.It usually occurred 10 to 13 days after the use of antibiotics.Body temperature returned to normal after discontinuation of antibiotics. |
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