P1467Ambulatory implantation of cardiac rhythm management devices: a retrospective safety and cost-minimization analysis in a developing country

Abstract

Abstract Introduction The monetary costs and safety of ambulatory implantation of cardiac rhythm management devices (CRMD) has been previously studied in many developed countries, but few of these analyses come from developing countries. Here we present a summary of complications and comparative costs of ambulatory implantation of CRMDs sourced from a set of cases logged in a large database of a public facility from a developing country, over a period of 6 years. Purpose To determine the number and type of complications in ambulatory implantation of CRMDs and to perform a cost-minimization analysis of the outpatient versus the implantation with hospital admission. Methods We performed a retrospective study using the database of CRMDs that included implantation procedures of unicameral (UNI) and bicameral (BI) pacemakers, implantable cardiac defibrillators (ICD) and generator replacements (RPL) from September 2012 to December 2018, in order to determine the number of patients that received the device in ambulatory and hospitalization regimens. Then, we reviewed the medical records to determine the complication rate during the first month in both modalities. Finally, we compared the ambulatory implant costs, including hospital day-care, against the costs of a two-day hospitalization, one of these being spent in an intermediate-care unit and the other in general hospitalization. Results We identified a total of 541 procedures; mean age 70 ± 14 years; 227 (42%) female patients. From these, 361 were ambulatory (66,7%), 45% being BI implantation, 38% RPL, 9% UNI implantation and 8% ICD implantation. Of this, 81% of the procedures were for AV block, 7% for sinus node dysfunction and 12% for sudden death prevention (primary or secondary). There were a significant lower number of complications in the ambulatory group (3,9%, n = 14) compared with the hospitalization group (11,6%, n = 15) p = 0,006 (X²) , with no CRMDs emergencies, fatal complications or emergency readmissions in either group. Complications included pneumothorax, deep venous thrombosis, endocarditis, lead displacement and local hematoma. The cost of an ambulatory CRMD implantation was 65 USD whereas the same procedure with hospital admission was 675 USD, according with the payment units valid for our country. Conclusion Ambulatory implantation of all CRMDS is feasible and safe. This modality implies a significant monetary saving that directly benefits the patients and the social security system. It can be done in a tertiary level hospital that can reach the whole quality standards for these interventions.