OBJECTIVES: Rates of implantable cardioverter-defibrillator (ICD) complications requiring transvenous (TV) lead reoperation have been documented. However, the resource use and costs of these complications are less understood. The objectives of this study were to estimate the Medicare costs and hospital length of stay (LOS) for ICD complications that required inpatient admission for repositioning, repair, or removal (reoperation) of TV leads. METHODS: Using Medicare administrative and claims data, we identified 1,068 patients, age ≥ 65, who were hospitalized for reoperation of ICD TV leads between 1/1/2011 and 12/31/2013. We calculated the total cost to Medicare of each admission, including inpatient facility and professional costs, and performed unadjusted and adjusted analyses to identify factors associated with variation in the total costs and LOS for these admissions. RESULTS: The mean age was 78, 61% were female, 92% were white, and 27% had a Charlson Comorbidity score ≥ 5. A majority of patients (70%) underwent lead removal, 26% underwent repositioning, and the remainder underwent repair. Mean LOS was statistically significantly longer for patients who underwent lead removal (12.3 days; 95% Confidence interval [CI]=11.4-13.2) than for those who underwent lead repair (6.4 days; 95% CI=2.8-10.0), or repositioning (7.0 days; 95% CI=5.5-8.5). Mean total cost also was significantly higher for patients who underwent lead removal ($45,838; 95% CI=$42,967-$48,708), than for repair ($32,767; 95% CI=$21,574-$43,960), or repositioning ($28,347 days; 95% CI=$23,614-$33,081). Among those who underwent removal, infection was associated with significantly longer LOS (+10.3 days; 95% CI 8.2-12.3) and higher total cost (+$11,690; 95%CI $5,143-$18,237). CONCLUSIONS: The economic consequences of ICD complications that require inpatient admission for reoperation of TV leads are substantial, especially in those who require lead removal in the presence of infection. Understanding the economic consequences of TV lead complications is essential to estimating the potential cost offsets associated with reducing these rates.