Implantation of permanent pacemakers in the electrophysiology laboratory: what it has changed in a general teaching hospital.
BACKGROUND
Analysis of surveys concerning current practice in pacemaker implantation has shown a difference between the United States and Canada: almost 70% of pacemakers are implanted in the operating room (OR) by surgeons in Canada, while in the United States, 70% of the implantations are done in a catheterization laboratory.


OBJECTIVE
To analyze the impact (in terms of complications, time on the waiting list, length of hospitalization and costs) of moving surgery from the OR to the electrophysiology laboratory (EPL) in a 450-bed Canadian teaching hospital. Data were collected on 100 consecutive implantations in the OR and, subsequently, on 100 procedures in the EPL.


RESULTS
The populations were identical in age (68+/-18 and 69+/-18 years, respectively) and sex ratio (both groups were 58% male). The implantation technique differed: the subclavian approach was used in 73% of patients in the OR group and in 99% of those in the EPL group. Antibiotic prophylaxis was given to all patients. The dual chamber rate was 22% in the OR group and 28% in the EPL group. Complication rates were similar in the two groups. Eleven per cent of procedures in the OR group and 46% in the EPL group were elective. For patients who underwent nonelective surgery, the time from indication to implantation was reduced from 3.3+/-2.6 days in the OR group to 1. 9+/-1.8 days in the EPL group (P=0.0005), and the total stay in hospital was 10.2+/-7.4 days and 6.9+/-7.8 days, respectively (P=0. 01). For both elective and nonelective surgery, the total stay in hospital was 9.2+/-7.4 days in the OR group and 4.2+/-6.4 days in the EPL group (P<0.00001). The overall cost reduction, taking into account an arbitrary earlier discharge in the EPL group, was almost 50%.


CONCLUSIONS
In this general teaching hospital, moving pacemaker implantation surgery from the OR to the EPL was safe and reduced by almost 50% the hospitalization stay by reducing the delay before implantation and by allowing elective surgery.
Hôpital du Sacré-C ur de Montréal, Montréal, Canada. Franck.Molin@umontreal.ca
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D000368:Aged; D001145:Arrhythmias, Cardiac / Q000628:therapy; D002170:Canada; D003362:Cost-Benefit Analysis; D004594:Electrophysiology; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007755:Laboratories, Hospital / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D010138:Pacemaker, Artificial; D019919:Prosthesis Implantation / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome