Day-case device implantationA prospective single-center experience including patient satisfaction data

PurposeMany centers perform day-case cardiac rhythm management (CRM) device implantation. However, there is a paucity of prospective data concerning this approach. We performed a prospective single-center study of day-case device implantation, including data on patient satisfaction. MethodsAll patients scheduled for a new elective device were considered for a day-case procedure. Exclusion criteria were living alone or without a suitable carer, advancing age/frailty, a metallic valve, and persistent complete heart block. Following discharge, patients were reviewed in device clinic at 6weeks with an anonymized questionnaire. ResultsDuring the study period (May 2014-August 2016), 797 new CRM devices were implanted. Of these, 232 were elective and included in the analysis; 101 were planned to be day-case and 131 scheduled for overnight stay. Of the 101 day-case patients, 52 had a pacemaker, 28 an implantable cardioverter defibrillator (ICD), 16 a cardiac resynchronization therapy pacemaker/defibrillator, and five a subcutaneous-ICD. Complications were similar in the day-case (n=12, 12%) and overnight stay (n=15, 11%) groups (P=0.92). In the day-case group, 93 (92%) patients went home the same day. An estimated 111 overnight bed days were saved, translating to a cost saving of 61,912 (euro 70,767, $79,211). Note that 99% (n=100) of patients returned the questionnaire. Patient satisfaction was universally high. The majority (n=98, 98%) felt ready to go home on discharge; only a minority (n=5, 5%) would have preferred an overnight stay. ConclusionsA significant proportion of elective new CRM device implants can be performed as day-case procedures. With appropriate selection patient acceptability of same-day discharge is high.