Early discharge after temporary epicardial pacing wire removal: a retrospective cohort study

Abstract

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.