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OK To Discharge ICD Patients On Same Day

Fri, 05/24/2013 - 10:54am
Chris Kaiser

Same-day discharge for patients receiving an implantable cardioverter defibrillator (ICD) is safe, feasible, and cost-effective, a retrospective study found.

There were no cardiac events, rehospitalizations, or procedure-related complications at 24 hours post-discharge for the 198 (79 percent) of 254 outpatients who had successful same-day discharge, reported Christian Machado, MD, of Providence Hospital and Medical Center in Providence, R.I., and colleagues.

At the 2-week wound check, six (2.8 percent) of these patients needed attention: four with minor surgical site bleeding, one with a hematoma, and one with fever and implantation-site swelling, according to the study published online in PACE.

The same-day discharge strategy proved to be cost effective as well. Compared with overnight observation, patients discharged on the same day saved $5,590 each.

"If we extrapolate this data to our 198 patients who were same-day discharges, a total of $1,106,820 was saved," Machado and colleagues wrote in conclusion.

Even the reason for patients being held for observation indicated the safety of same-day discharge. Of the 54 (21 percent) outpatients not discharged on the same day, only six had complications associated with the ICD. Other reasons included logistical issues and problems associated with comorbidities.

To be eligible for the study, patients had to have an indication for their ICD of primary prevention of sudden cardiac death. Those with a secondary prevention indication were excluded. Three-quarters of the patients received ICDs with single leads.

The safety of ICD implantation also extended to the inpatient population. Of the 53 inpatients in the study, none had major complications due to the procedure at 24 hours and four (7.5 percent) had hematomas at 2 weeks. The average hospital stay was 4.5 days.

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