Safety of same-day discharge versus overnight stay strategy following cardiac device implantations: a high-volume single-centre experience

Abstract

Background The strategy of cardiac implantable electronic device (CIED) implantations performed as day-case admissions has gained a wider acceptance overtime; however, data on safety are still limited. This study aims to investigate the safety of a same-day discharge protocol introduced in our hospital for the postprocedural management of patients undergoing CIED implantation. Methods Α prospective, non-interventional, non-randomised study performed in a single high-volume implanting centre for a 16-month period (March 2020 to June 2021). At total of 821 of 965 (85.1%) patients scheduled for elective CIED implantation were considered to be eligible for inclusion in the Short-stay Device Management Protocol. These patients were compared with a historical group of 932 patients, meeting the same inclusion criteria. Results Procedure was successful in 812 patients (98.9%), committed to same-day discharge versus 921 of 932 patients (98.8%) admitted for overnight stay ( p = 0.87). Overall, 90-day complication rate was comparable in both groups (4.14% vs 4.07%, p = 0.95), as was major (1.46% vs. 1.82%, p = 0.55) and minor (2.67% vs. 2.25%, p = 0.64) complication rates. The composite early post-procedural complication rates and late post-procedural complication rates were comparable among groups (0.97 vs 1.18%, p = 0.70 and 0.73% vs 0.64%, p = 0.83, respectively). Six hundred sixty-seven patients (84%) preferred the same-day discharge strategy. Finally, a reduction of 792 bed-days was recorded, resulting in possible financial Health System benefits. Conclusions Same-day discharge is feasible and safe in the majority of patients referred for CIED implantation. Additionally, same-day discharge is preferred by patients and may reduce procedure-related costs due to significant bed-day reductions. Supplementary Information The online version contains supplementary material available at 10.1007/s10840-022-01319-5.

Feasibility and Safety Study of Concomitant Left Bundle Branch Area Pacing and Atrioventricular Node Ablation with Same-Day Hospital Dismissal

“…The COVID-19 pandemic has dramatically affected the practice pattern in clinical cardiac electrophysiology. A wide variety of complex EP ablation and device implant procedures are currently performed with a same-day dismissal protocol in many institutions across the world [1,2]. This leads to decreased hospital stays with cost-saving implications, a potentially decreased risk of infection, and improved patient comfort and satisfaction without sacrifice in the clinical outcomes [1,2].…”

Optimal hospital discharge time after cardiac implantable electronic device implantation: A retrospective study from a tertiary electrotherapy center

“…Based on the literature data, it is known that most very early complications following CIED procedures occur within the first 6 hours after the procedure, which makes discharge from the hospital on the day of the procedure safe and preferred by patients [1][2][3]. Some authors go a step further, proposing discharge after transvenous lead extraction performed for non-infectious reasons on the same day [4].…”

Same day discharge after transvenous lead extraction: Balancing safety and efficiency

“…[1][2][3][4] Also, SDD after elective cardiac implantable electronic device (CIED) implantation procedures is an established model of care. 5,6 Improvement in the safety of atrial fibrillation ablation and left atrial appendage occlusion has led electrophysiologists to embrace SDD after these two procedures. [7][8][9] Transvenous lead extraction (TLE) is a procedure with a mortality rate up to 1% and major complications of 2%-3%.…”

“…The improvement in the safety of percutaneous coronary intervention (PCI) after the shift to transradial approach has made SDD after PCI a routine practice 1‐4 . Also, SDD after elective cardiac implantable electronic device (CIED) implantation procedures is an established model of care 5,6 . Improvement in the safety of atrial fibrillation ablation and left atrial appendage occlusion has led electrophysiologists to embrace SDD after these two procedures 7‐9 …”