title: Safety of Outpatient Implantation of the Implantable Cardioverter-defibrillator.
abstract: OBJECTIVE
  Strategies are needed to reduce health care costs and improve patient care. The objective of our study was to analyze the safety of outpatient implantation of cardioverter-defibrillators.
  
  
  METHODS
  A retrospective study was conducted in 401 consecutive patients who received an implantable cardioverter-defibrillator between 2007 and 2012. The rate of intervention-related complications was compared between 232 patients (58%) whose implantation was performed in the outpatient setting and 169 patients (42%) whose intervention was performed in the inpatient setting.
  
  
  RESULTS
  The mean age (standard deviation) of the patients was 62 (14) years; 336 (84%) were male. Outpatients had lower left ventricular ejection fraction and a higher percentage had an indication for primary prevention of sudden death, compared to inpatients. Only 21 outpatients (9%) required subsequent hospitalization. The rate of complications until the third month postimplantation was similar for outpatients (6.0%) and inpatients (5.3%); P = .763. In multivariate analysis, only previous anticoagulant therapy was related to the presence of complications (odds ratio = 3.2; 95% confidence interval, 1.4-7.4; P < .01), mainly due to an increased rate of pocket hematomas. Each outpatient implantation saved approximately €735.
  
  
  CONCLUSIONS
  Outpatient implantation of implantable cardioverter-defibrillators is safe and reduces costs. Close observation is recommended for patients receiving chronic anticoagulation therapy due to an increased risk of complications.
authors.affiliation: Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain. Electronic address: tomas.datino@gmail.com.
authors.forename: Tomás
authors.initials: T
authors.lastname: Datino
authors.affiliation: Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Miracle Blanco
authors.affiliation: Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Núñez García
authors.affiliation: Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Esteban
authors.initials: E
authors.lastname: González-Torrecilla
authors.affiliation: Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Felipe
authors.initials: F
authors.lastname: Atienza Fernández
authors.affiliation: Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Arenal Maíz
authors.affiliation: Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Hernández-Hernández
authors.affiliation: Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Ávila Alonso
authors.affiliation: Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Eidelman
authors.affiliation: Departamento de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital General Universitario Gregorio Marañón, Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Fernández-Avilés
mesh_terms: D000074:Acenocoumarol / Q000008:administration & dosage; D000553:Ambulatory Care / Q000191:economics; D000556:Ambulatory Surgical Procedures / Q000009:adverse effects* / Q000191:economics / Q000379:methods; D000925:Anticoagulants / Q000008:administration & dosage; D003365:Costs and Cost Analysis; D017147:Defibrillators, Implantable / Q000009:adverse effects* / Q000191:economics; D004334:Drug Administration Schedule; D017984:Enoxaparin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D011183:Postoperative Complications / Q000191:economics / Q000209:etiology; D019919:Prosthesis Implantation / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D012189:Retrospective Studies; D017180:Tachycardia, Ventricular / Q000191:economics / Q000628:therapy
chemical_list: D000925:Anticoagulants; D017984:Enoxaparin; D000074:Acenocoumarol
keywords: Desfibrilador automático implantable; Implantable cardioverter-defibrillator; Implante ambulatorio; Outpatient implantation; Safety; Seguridad