title: Replacing abdominally implanted defibrillators: effect of procedure setting on cost.
abstract: Although most ICDs are currently placed using a pectoral approach, there exists a large population of patients with abdominally implanted ICDs who will require device replacement due to a depleted battery. The purpose of this study was to compare the cost, convalescence, and complication rate of replacing abdominally implanted ICDs in the OR versus the EP laboratory. Between August 1993 and September 1994, we prospectively enlisted nine consecutive patients who presented for their second ICD generator replacement and who had a prior generator replacement in the OR 3-4 years earlier. The mean age of the patients was 63 +/- 17 years and their mean ejection fraction was 37% +/- 15%. ICD replacement was performed in the EP laboratory and consisted of explanting the old device, electronic interrogation of the lead system, and confirmation of defibrillation thresholds prior to implanting a new device. Local anesthesia was provided by lidocaine infiltration and sedation was achieved with intravenous (i.v.) midazolam and fentanyl. Following the procedure, the patients were returned to an outpatient monitored setting for 4 hours and were then discharged. Comparisons of the health care charges for the same procedure performed in the two different settings revealed a significant reduction in physician fees (from $3,621 +/- $556 to $2,179 +/- $577, P < 0.05), in hospital charges (from $5,811 +/- $1,102 to $2,306 +/- 696, P < 0.05), and in total charges (from $9,431 +/- $1,375 to $4,541 +/- $1,010, P < 0.05), exclusive of ICD cost, when the procedure was performed on an outpatient basis in the EP laboratory. Inpatient days averaged 3.0 +/- 0.3 when the procedure was performed in the OR. On long-term follow-up there were no complications following abdominal ICD generator replacement in the OR (mean follow-up, 39 +/- 2 months) or in the EP laboratory (mean follow-up, 42 +/- 4 months). Thus, ICD replacements in the EP laboratory cost less than in the OR due to significantly lower physician fees, hospital charges, and a shorter postprocedural convalescence.
authors.affiliation: Department of Medicine, University of Wisconsin School of Medicine, Madison, USA. vrv@medicine.wisc.edu
authors.forename: V R
authors.initials: VR
authors.lastname: Vorperian
authors.forename: S
authors.initials: S
authors.lastname: Lawrence
authors.forename: K
authors.initials: K
authors.lastname: Chlebowski
mesh_terms: D000005:Abdomen; D000554:Ambulatory Care Facilities / Q000191:economics*; D003362:Cost-Benefit Analysis; D016757:Death, Sudden, Cardiac / Q000517:prevention & control; D017147:Defibrillators, Implantable / Q000191:economics*; D004594:Electrophysiology / Q000191:economics; D005260:Female; D017048:Health Care Costs; D017722:Hospital Charges; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000191:economics; D011446:Prospective Studies; D012086:Reoperation; D017180:Tachycardia, Ventricular / Q000628:therapy