title: Safety and cost-effectiveness of same day permanent pacemaker implantation.
abstract: An overnight stay after permanent pacemaker implantation has major cost implications for healthcare systems. Same day pacing could be effective in alleviating this. We evaluated our elective same day pacing practice to determine safety and cost-effectiveness. A total of 780 patients were scheduled for elective new permanent pacemaker implantation as a same day procedure at the University Hospital, North Staffordshire, from April 2001 to December 2006. The mean age +/- SEM of the cohort was 73.8 +/- 0.4 years (464 men and 316 women). Single-chamber devices were implanted in 272 (27 atrial and 245 ventricular) and dual chamber in 508 patients. Vascular access was by the subclavian vein in 431 patients and the cephalic vein in 349. Preimplant intravenous antibiotics were administered to 28% and perioperative antibiotics to the remainder; all patients received oral antibiotics after implantation. Of the 780 patients, 41 (5.3%) required an in-hospital stay after implantation because of hematoma formation in 12, pneumothorax in 3, social reasons for 7, observation at the physicians request but no complication for 13, angina in 3, arrhythmia in 1, and warfarin therapy in 2. Immediate complications (<24 hours) occurred in 6 patients and early complications (>24 hours to 6 weeks) developed in 17. Of the 780 patients, 94 had died at mean follow-up of 2.4 +/- 0.1 years; none were related to pacemaker implantation. An overnight stay at our hospital costs pound203.60 ( approximately US$305). From November 2005 to November 2006, 109 patients underwent same day implantation, resulting in a cost saving of pound22,192.40 ( approximately US$34,500). In conclusion, same day permanent pacemaker implantation was feasible, safe, and cost-effective. It was associated with a low prevalence of complications and only a few patients required an overnight stay.
authors.affiliation: Department of Cardiology, University Hospital Coventry, Coventry, United Kingdom. faizel.osman@btinternet.com
authors.forename: Faizel
authors.initials: F
authors.lastname: Osman
authors.forename: Suresh
authors.initials: S
authors.lastname: Krishnamoorthy
authors.forename: Adnan
authors.initials: A
authors.lastname: Nadir
authors.forename: Phillip
authors.initials: P
authors.lastname: Mullin
authors.forename: Adrian
authors.initials: A
authors.lastname: Morley-Davies
authors.forename: John
authors.initials: J
authors.lastname: Creamer
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D016009:Chi-Square Distribution; D003362:Cost-Benefit Analysis / Q000191:economics*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D010138:Pacemaker, Artificial / Q000009:adverse effects / Q000191:economics*; D012449:Safety; D018709:Statistics, Nonparametric; D016896:Treatment Outcome