title: An electrical plasma surgery tool for device replacement--retrospective evaluation of complications and economic evaluation of costs and resource use.
abstract: BACKGROUND
  Device replacements bear many potential risks for patients. Electrocautery should be used cautiously because of heating of the cautery tip which may lead to insulation melting. The PEAK PlasmaBlade™ (Medtronic Inc., Minneapolis, MN, USA) uses a novel technology to cut tissue. The objective of this study was to evaluate if this instrument is less destructive and can decrease complications and shorten procedure times.
  
  
  RESULTS
  Two groups were compared: in group 1, surgery was done with scissors and conventional electrocautery, whereas the PEAK PlasmaBlade™ was used in group 2. Procedure time and complication rates were retrospectively investigated. Group 1 comprised 509 patients, while group 2 consisted of 102 patients. Procedure time in group 2 was significantly shorter with 28.4 ± 8.9 minutes than in group 1 with 47.5 ± 24.5 minutes (P < 0.001). The hospital stay was also reduced (2.1 ± 2.2 days versus 3.1 ± 2.4 days, P < 0.001). One major complication occurred in only 2.4% (two patients) of group 2 and in 6.9% (35 patients) of group 1. There were no damaged leads in group 2 compared to 5.7% in group 1 (P = 0.008). Cost analyses showed that the use of The PEAK PlasmaBlade™ instead of conventional electrocautery resulted in cost savings of €120/patient.
  
  
  CONCLUSIONS
  Device replacement is associated with a notable complication risk. Our investigation showed that a new device for generator replacement resulted in significantly reduced procedure time and length of hospital stay while completely avoiding lead damage, which translated into considerable cost savings in a real world setting.
authors.affiliation: Cardiovascular Division, Department of Internal Medicine I, General Hospital Linz, Linz, Austria.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kypta
authors.forename: Hermann
authors.initials: H
authors.lastname: Blessberger
authors.forename: Karim
authors.initials: K
authors.lastname: Saleh
authors.forename: Simon
authors.initials: S
authors.lastname: Hönig
authors.forename: Jürgen
authors.initials: J
authors.lastname: Kammler
authors.forename: Kurt
authors.initials: K
authors.lastname: Neeser
authors.forename: Clemens
authors.initials: C
authors.lastname: Steinwender
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058409:Cardiac Resynchronization Therapy Devices; D002648:Child; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D020878:Device Removal / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation*; D004598:Electrosurgery / Q000009:adverse effects / Q000191:economics* / Q000295:instrumentation*; D004867:Equipment Design; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
keywords: PEAK PlasmaBlade™; complication rate; complication rates; device replacement; generator replacement; procedure related costs; surgery tool