Same‐day discharge after implantation of cardiac implantable electronic devices: A systematic review and meta‐analysis

Abstract

Background: Due to an increasing need for cardiac implantable electronic device (CIED) placement, the cost of healthcare has been rising including the cost of hospital stay after the procedure. We conducted this systematic review and meta-analysis to assess the safety and feasibility of same-day discharge (SDD) after cardiac device implantations. Methods:We searched MEDLINE, and Embase databases from inception to March 2021 to identify studies that compared clinical outcomes between SDD group and hospital overnight stay (HO) group after cardiac device implantations. Outcomes included complications after the procedure, mortality, and re-hospitalization. Data from each study were combined using the random-effects model to calculate pooled odds ratio (OR) with 95% confidence interval (CI).Results: Eight studies (one randomized control trial, three prospective cohort and four retrospective cohort studies) with a total of 61,602 patients (4153 in SDD group and 57,449 in HO group) were included. SDD was not associated with more procedure-related complications. The rates of wound problems (0.94% vs 1.84%, pooled OR = 0.86, 95%CI: 0.2-3.68, p = .834), pneumothorax (1.15% vs 0.73%, pooled

Safety and feasibility of same‐day discharge following uncomplicated transvenous lead extraction

“…SDD has been shown to be safe for a variety of complex interventional electrophysiology procedures, including device implantation, atrial fibrillation ablation, and left atrial appendage occlusion with Watchman. [11][12][13] SDD is appealing to both patients and hospitals, leading to increased patient satisfaction and cost efficiency.…”

Differences in patient characteristics, clinical practice and outcomes of cardiac implantable electric device therapy between Japan and the USA: a cross-sectional study using data from nationally representative administrative databases

“…Therefore, both hospitals and patients have little financial incentive to shorten hospital stays. Based on the reports that most of the potentially fatal complications occur within 3 days, 32 and that same-day discharge after CIED implantation was not associated with higher risk of complications or readmission compared with overnight hospital stay, 33 hospitalisation period for CIED implantation in Japan is very long. In Japan, patients are usually discharged after confirming that the wound has healed, and that heart failure did not develop due to the physiologic change by a new CIED or an invasion by implantation surgery.…”

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 …”