PERMANENT PACEMAKER IMPLANTATION AFTER CARDIAC TRANSPLANTATION - EXTRA COST OF A CONSERVATIVE POLICY

Objective-To determine the costs of a change in permanent pacemaker im plantation policy to later imp,lantation (day 21+) after cardiac trans plantation. Design-Retrospective review of patient records including d uration of temporary pacing, time of permanent pacemaker implantation, and length of hospital stay for every patient surviving greater than or equal to 14 days from November 1990 to August 1995 (period 2) and f or all patients in whom permanent pacemakers were implanted between Ma y 1985 and November 1990 (period 1). Setting-Supra-regional cardiopulm onary transplant unit. Patients-335 consecutive adult cardiac transpla nt recipients at Freeman Hospital between May 1985 and August 1995. Ma in outcome measures-The cost of the policy change was calculated by su btraction of the overall saving in pacemaker implantations from the ov erall cost of the extra inpatient stay in period 2 due to delayed impl antation. Results-Mean inpatient stay per patient following cardiac tr ansplantation of permanent pacemaker recipients in period 1 was 13.8 d ays compared with 23.9 days in period 2 (P < 0.001). The cost of this extended hospital stay is pound 60 095. Had the implantation policy no t been changed, a further seven patients would have received a permane nt pacemaker in period 2. A saving in pacemaker hardware of pound 16 2 75 was made. Overall, however, the new permanent pacemaker implantatio n policy increased expenditure by pound 43 820, assuming that permanen t pacemaker implantation was the only reason for the extended hospital stay. Conclusion-The change in policy from early to later permanent p acemaker has markedly increased implantation expenditure.