Same-day discharge after implantation of cardiac implantable electronic devices: A systematic review and meta-analysis.

Abstract

Due to an increasing need for cardiac implantable electronic device (CIED) placement, the cost of healthcare has been rising including the cost of hospital stay after the procedure. We conducted this systematic review and meta-analysis to assess the safety and feasibility of same-day discharge (SDD) after cardiac device implantations. We searched MEDLINE, and Embase databases from inception to March 2021 to identify studies that compared clinical outcomes between SDD group and hospital overnight stay (HO) group after cardiac device implantations. Outcomes included complications after the procedure, mortality, and re-hospitalization. Data from each study were combined using the random-effects model to calculate pooled odds ratio (OR) with 95% confidence interval (CI). Eight studies (one randomized control trial, three prospective cohort and four retrospective cohort studies) with a total of 61,602 patients (4153 in SDD group and 57,449 in HO group) were included. SDD was not associated with more procedure-related complications. The rates of wound problems (0.94%vs 1.84%, pooled OR=0.86, 95%CI: 0.2-3.68, p=.834), pneumothorax (1.15%vs 0.73%, pooled OR=1.36, 95%CI: 0.26-7.12, p=.718), hematoma (0.59%vs 2.32%, pooled OR=0.35, 95%CI:0.01-9.85, p=.534), lead/device dislodgement (4%vs 2.48%, pooled OR=1.71, 95%CI: 0.64-4.54, p=.281), readmission rate (17.6%vs 17.5%, pooled OR=0.95, 95%CI: 0.74-1.21, p=.667), and mortality rate (1.66%vs 1.44%, pooled OR=0.77, 95%CI: 0.58-1.01, p=.059) were similar between in SDD and HO groups respectively. Our meta-analysis suggested that SDD after cardiac device implantations might be a safe and feasible alternative to HO without differences in procedure-related complications, readmission rates, or mortality rates.