Same-day discharge after transvenous lead extraction: feasibility and outcomes

Abstract

Aims Same-day discharge (SDD) is safe for patients undergoing electrophysiology procedures. There is no existing data regarding SDD for patients undergoing transvenous lead extraction (TLE). We report our experience with SDD for patients undergoing TLE. Methods and results The study group included patients undergoing TLE between February 2020 and July 2021 without an infectious indication. A modified SDD protocol for device implants/ablations was applied to TLE patients. Patient characteristics, extraction details, outcomes, and complications were reviewed. Of 239 patients undergoing TLE, 210 were excluded (94 infections and 116 did not meet SDD criteria). Of the remaining 29 patients, seven stayed due to patient preference and 22 were discharged home the same day. The SDD group had an average age of 65.9 ± 12 (47–84), 41% female, and LVEF of 52.2 ± 18% (10–80). The indication for TLE was malfunction (20), upgrade (4), advisory lead (2), and magnetic resonance imaging compatibility (1). Extractions included four implantable cardioverter-defibrillators (ICDs), 17 pacemakers (PPM), and one cardiac resynchronization therapy (CRT)-P system. The leads were 9.6 years (1.5–21.7) old, and 1.8 leads were removed per patient (1–3); the lead extraction difficulty (LED) score was 11.6 ± 7. Twenty underwent cardiovascular implantable electronic device (CIED) re-implantation (2 ICD, 3 CRT-D, 13 PPM, and 2 CRT-P). For CIED re-implants, patients sent a remote transmission the next day, and all patients received a next-day call. There were no procedure or device-related issues, morbidities, or mortalities in the 30 days after discharge. Conclusion Same-day discharge after TLE for non-infectious aetiologies is safe and feasible in a select group of patients with early procedure completion who meet strict SDD criteria.

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

“…| 285 feasibility of SDD for TLE. 4,5 More specifically, in this cohort, we found that the only significant predictor of SDD remains a procedure end-time before 12:00. This does not confirm the findings of Dagher et al, which identified a higher procedure complexity (more extracted leads, with longer dwell times, using more advanced tools and techniques) as a predictor of overnight stay.…”

“…4,5 In their case series, Atteya et al described the characteristics and outcomes of 22 patients who were discharged the same day following TLE for a noninfectious indication, with no reported 30-day procedure-or device-related complications. 4 In their case-control study of patients undergoing elective TLE for a noninfectious indication, Dagher et al compared those who were discharged the same day (n = 80) with those who stayed overnight due to the occurrence of immediate procedure-related complications (n = 31), confirming the safety of an SDD approach, with no reported major procedure-related complications. 5 Our study adds to the existing body of knowledge, because it is the first one evaluating the safety of SDD in patients following uncomplicated TLE (i.e., patients with immediate complications were not included) for any indication (i.e., patients with an infectious indication were included).…”

“…2 There is a paucity of data on the safety of SDD after TLE. [3][4][5] In our center, we routinely discharge patients the same day after an uncomplicated TLE: herein, we sought to review our experience with SDD in selected patients following uncomplicated TLE, to shed more light on patient selection and to evaluate the safety of our practice.…”

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

“…Of note, SDD was strongly considered when patients had good social support, the procedure was not deemed complicated, postprocedure recovery was smooth, and when no minor or major complications were seen. Attaya et al 17 reported safe outcomes of SDD after TLE in patients who met pre‐specified criteria, including early procedure time, no need for anticoagulation, physician judgment, and patient social situation.…”

“…Of note, SDD was strongly considered when patients had good social support, the procedure was not deemed complicated, postprocedure recovery was smooth, and when no minor or major complications were seen. Attaya et al 17 SDD allows for better healthcare utilization and saves costs in an environment where hospitals suffer from financial constraints and are constantly operating at near-maximal capacity. 18 These two factors were further magnified during the COVID-19 pandemic when preserving hospital resources for people who need it most became of paramount importance.…”