Key result
Discharge within 24h of pacing wire removal showed no difference in acute (P=0.646) or long-term complications (P=0.118) vs later discharge, though INR >2 increased long-term risk (40.9% vs 16.2%).
Why the study?
Complications related to epicardial pacing wire removal can be fatal, yet there are no nationally recognised guidelines on wire removal or safe discharge timing thereafter.
Does discharge within 4-24 hours after temporary epicardial pacing wire removal increase complications in stable cardiac surgery patients?
Cohort (n=250)
No
Does discharge within 4-24 hours after temporary epicardial pacing wire removal increase complications in stable cardiac surgery patients?
p-value: p=0.646 for acute, 0.118 for long-term
Discharging stable cardiac surgery patients within 24 hours after temporary epicardial pacing wire removal appears safe, though patients with high resistance to removal or INR >2 require closer monitoring.
Supports early discharge feasibility after pacing wire removal; hypothesis-generating and should not yet change practice.
Background/Aims Insertion of temporary epicardial pacing wires is a common procedure following cardiac surgery. Complications related to their removal, though rare, can be fatal. There are no nationally recognised guidelines on the removal of pacing wires or safe discharge thereafter. This study aimed to evaluate the safety of discharging stable cardiac surgery patients, who meet all other discharge criteria, within 4–24 hours of epicardial pacing wire removal. Methods A single-centre retrospective cohort study was conducted with all consecutive cardiac surgery patients who underwent temporary pacing wire insertion at a tertiary centre for cardiac surgery (n=250). Patient records were retrospectively reviewed to extract and collate variables related to the procedure, as well as acute and long-term adverse outcomes. Data were analysed using a variety of statistical tests, with P<0.005 being taken to indicate significance. Results No significant difference was observed in the incidence of acute (P=0.646) or long-term complications (P=0.118) between patients discharged before 24 hours after wire removal and those discharged later. Patients with moderate or severe resistance to removal were significantly more likely to experience acute complications (P<0.001). Patients with an international normalised ratio of >2 at removal showed significantly more long-term complications (40.9% vs 16.2%, P=0.02). Conclusions The practice of discharging patients within 24 hours after pacing wire removal, if all other discharge criteria are met, is safe. High resistance and an elevated international normalised ratio (>2) at the time of removal are independent predictors of acute and long-term complications. Such patients should be closely monitored after removal and might benefit from delayed discharge. Further research should be conducted to make this study's results more generalisable and to formulate guidelines to standardise practice.
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Bruno et al. (2021) conducted a cohort in Cardiac surgery (n=250). Discharge within 4-24 hours of epicardial pacing wire removal vs. Discharge later than 24 hours was evaluated on Acute and long-term complications (p=0.646 for acute, 0.118 for long-term). Discharge within 24h of pacing wire removal showed no difference in acute (P=0.646) or long-term complications (P=0.118) vs later discharge, though INR >2 increased long-term risk (40.9% vs 16.2%).
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