Key result
An ambulatory cardiac pacing program reduced operational costs by $3,976 per case and saved 1,456 bed days, with a first-year lead dislodgment rate of 20% compared to 11% for previous inpatients.
Why the study?
Does an ambulatory pacing system implantation program improve economic outcomes and maintain safety compared to inpatient implantation in patients requiring pacemakers?
Observational (n=204)
Does an ambulatory pacing system implantation program improve economic outcomes and maintain safety compared to inpatient implantation in patients requiring pacemakers?
An ambulatory cardiac pacing program significantly reduces hospital bed utilization and operational costs, demonstrating it is a practical and economical approach despite slightly higher initial complication rates.
Ambulatory pacing was associated with cost and bed-day savings; leaves open whether higher dislodgment rates are acceptable without randomized data.
UNLABELLED: The purpose of this review was to evaluate the economical benefits and outcomes of an ambulatory pacing system implantation program that began in 1991 for new and replacement pacing system implantations. Patient access, incidence of complications, hospital bed day utilization, economic impact, safety, and practicality of the Ambulatory Pacing System Implantation Program was retrospectively reviewed from August 1991 to March 1994. The Ambulatory Pacing System Implantation Program includes pre-operative outpatient assessment in the pacemaker clinic, admission to the Day Medical Unit followed by same day pacing system implantation, discharge home after a short period of observation, and, in selected cases, cardiac monitoring, followed by pacemaker clinic visit 24-hours postimplantation. RESULTS: Two hundred four cardiac pacing systems, 154 new and 50 replacements (pulse generator/leads), were implanted under the guidelines of the Ambulatory Pacing System Implantation Program between August 1991 and March 1994. Eighty-seven percent of the patients were implanted with passive fixation leads, the remaining with active fixation leads; all but four of which were leads implanted in the atria. Preprocedure wait time was decreased from 16 to 2 days for elective pacing system implantation. The incidence of lead dislodgment in the first, second, and third year of the Ambulatory Pacing System Implantation Program was 20%, 12%, 5%, respectively; compared to 11% for a similar number of cases in previous years done as inpatients. The incidence of new infection was 2.4% compared to < 1% in previous years. Six of the 204 (2%) cases required admission overnight. A total savings of 1,456 bed days ($1,275,450.00; Canadian) has been realized for an equivalent number of cases when compared with previous years. The operational cost was reduced by $3,976.00 per case. CONCLUSION: It has been shown that the Ambulatory Pacing System Implantation Program has improved client access, and is a safe and economical approach to implantation of cardiac pacing systems.
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Irwin et al. (1994) conducted an observational in Cardiac pacing system implantation (n=204). Ambulatory Pacing System Implantation Program vs. Inpatient implantation (historical control) was evaluated on Incidence of lead dislodgment in the first year. An ambulatory cardiac pacing program reduced operational costs by $3,976 per case and saved 1,456 bed days, with a first-year lead dislodgment rate of 20% compared to 11% for previous inpatients.
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