PO-03-051 EXPEDITED SAME DAY DISCHARGE PROTOCOL IS SAFE FOR PATIENTS UNDERGOING CARDIAC IMPLANTABLE ELECTRONIC DEVICE (CIED) IMPLANTATION

Abstract

Prior studies have demonstrated the safety of same day discharge in appropriately selected patients undergoing CIED implantation though a limitation is the requirement for prolonged post-operative observation. There is limited data on whether expedited discharge pathways, which can reduce post-operative resource utilization, can offer comparably safe outcomes. To evaluate outcomes of an expedited same day discharge (SDD) protocol across the hospitals. All patients undergoing pacemaker and ICD implantation between 2018-2021 at three hospitals were identified. The post-operative pathway for SDD included a two-hour (1) PA/lateral chest x-ray (2) device interrogation including set up for remote monitoring and (3) bedside evaluation. This protocol was implemented over the study period and use was at physician discretion. Patients’ sociodemographics, comorbidities, and procedure were retrospectively collected. Outcomes included 30-days post-implant unplanned healthcare utilization (urgent care, emergency department, or hospital visits) as well as 90-day infections. Differences between SDD versus not same day discharge patients were assessed using chi-square test for categorical variables and t-test for continuous variables. Multivariate logistic regression analysis was used to evaluate the association between discharge grouping and outcomes of interest. Between 2018-2021, 4872 patients underwent CIED implantation and 28.3% were discharged same day. As summarized in Table 1, compared to SDD, patients not discharged on the same day were older, more likely to be female, and had a higher incidence of comorbidities including hypertension, diabetes mellitus, stroke, and heart failure. Among patients discharged on the same day, the mean time to chest x-ray post-operatively was 2.8 (SD±1.8) hours. Adjusting for the baseline characteristics, SDD patients had signficantly lower 30-day unplanned healthcare utilization (AOR: 0.49 95%CI: 0.40-0.59), complications (AOR: 0.60 95%CI: 0.38-0.93) and mortality (AOR: 0.19 95%CI: 0.06-0.62). Additionally, 90-day infection rates were not significantly different based on discharge grouping. An expedited SDD protocol using a two-hour post-implant evaluation protocol in appropriately selected patients appears to be safe without an increase in adverse events compared to patients hospitalized post-operatively for extended observation. Further investigation to define patient selection criteria is warranted.