Abstract 13293: Safety of Same-Day Discharge After Implantable Cardioverter Defibrillator or Permanent Pacemaker Implant: A Single-Center Experience
Objective: HRS/EHRA Consensus recommends that follow-up post-device implant must be individualized to device and patient-related factors. Also, postimplant monitoring within 24 hours should include predischarge physical exam and chest X-ray (CXR) to rule out pneumothorax, lead dislocation and perforation. Follow-up within four weeks post-discharge is recommended. HRS/EHRA does not advise mandatory overnight hospital stay. No detailed studies have evaluated necessity of overnight stay post-device implantation.
Methods: We retrospectively analyzed 268 consecutive patients who presented for device implantation and compared their outcomes with respect to the timing of discharge: same-day versus next-day discharge. Biventricular implants, patients with complete heart block and patients requiring postoperative reinitiation of anticoagulation therapy were excluded. Patients were followed for a minimum of 1 month. Same-Day Group (n=78): 48 implantable cardioverter defibrillators (ICDs) and 30 permanent pacemakers (PPMs) were implanted and patients discharged the same day after postoperative physical exam and CXR four hours later. Next-Day Group (n=187): 95 ICDs and 92 PPMs were implanted and patients discharged after physical exam, CXR and device interrogation the day after implantation. All patients received perioperative intravenous antibiotic (two doses total). End points included pneumothorax, lead dislodgement, cardiac perforation, pocket hematoma, pocket/device infection and death.
Results: Same-Day Group had no complications during follow-up. Next-Day Group had four complications: two predischarge complications, both pneumothorax, and two complications post-discharge, including one pocket infection and one inappropriate ICD shock secondary to lead dislodgment. Same-day discharged patients had hospital savings of an overnight stay and 24-hour nursing costs.
Conclusions: This retrospective feasibility analysis on low-risk patients did not show a higher association of complications in same-day discharge patients compared to next-day discharge patients. Thus, there may be a substantial hospital cost-benefit. Larger studies are needed for further evaluation.
- © 2011 by American Heart Association, Inc.