title: Analysis of charges and complications of permanent pacemaker implantation in the cardiac catheterization laboratory versus the operating room.
abstract: During the last two decades, an increasing number of permanent pacemakers have been implanted outside of the operating room (OR) by nonsurgeons. Previous investigators have demonstrated that pacemakers can be safely implanted in the cardiac catheterization laboratory with no increase in complications or infections. This is the first study of its kind to simultaneously evaluate cost, length of hospitalization, and complications between pacemakers implanted in the OR by surgeons with those implanted in the catheterization laboratory by an electrophysiologist. A total of 254 consecutive pacemaker implants were analyzed over a 2-year period. The OR group consisted of 122 patients with a mean age of 64 +/- 21 years versus 132 patients in the catheterization laboratory group with a mean age of 65 +/- 17 years. The indication and type of pacemaker implanted were similar among both groups with 78% of OR patients and 73% of catheterization laboratory patients receiving dual chamber devices. The average cost for pacemaker implantation in our study was significantly higher in the OR group $5,464 +/- $1,670 versus $2,682 +/- $8 for the catheterization laboratory group (P < 0.001). There was a reduction in preimplant days in the catheterization laboratory group 3.16 +/- 12.40 days versus 5.65 +/- 9.54 days in the OR group (P < 0.05). Complications were minimal and there were no significant differences between the two groups. This study confirms that pacemakers can be safely implanted in the catheterization laboratory by nonsurgeons with no increase in complications and a significant reduction in hospital costs.
authors.affiliation: Department of Medicine, University of Miami School of Medicine and Jackson Memorial Hospital, Florida 33101, USA.
authors.forename: K H
authors.initials: KH
authors.lastname: Yamamura
authors.forename: E M
authors.initials: EM
authors.lastname: Kloosterman
authors.forename: J
authors.initials: J
authors.lastname: Alba
authors.forename: F
authors.initials: F
authors.lastname: Garcia
authors.forename: P L
authors.initials: PL
authors.lastname: Williams
authors.forename: R D
authors.initials: RD
authors.lastname: Mitran
authors.forename: A
authors.initials: A
authors.lastname: Interian
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000191:economics*; D016022:Case-Control Studies; D004594:Electrophysiology; D005260:Female; D013502:General Surgery; D017722:Hospital Charges; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007753:Laboratories / Q000191:economics*; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000191:economics*; D010138:Pacemaker, Artificial / Q000009:adverse effects / Q000145:classification / Q000191:economics*; D011446:Prospective Studies; D015642:Radiology, Interventional; D012189:Retrospective Studies; D012449:Safety