Replacing abdominally implanted defibrillators: Effect of procedure setting on cost

Although most ICDs are currently placed using a pectoral approach, there ex ists or large population of patients with abdominally implanted ICDs who wi ll require device replacement due to a depleted battery. The purpose of thi s study was to compare the cost, convalescence, and complication rate of re placing abdominally implanted ICDs in the OR versus the EP laboratory. Betw een August 1993 and September 1994, we prospectively enlisted nine consecut ive patients who presented for their second ICD generator replacement and w ho had a prior generator replacement in the OR 3-4 years earlier. The mean age of the patients was 63 +/- 17 years and their mean ejection fraction wa s 37% +/- 15%. ICD replacement was performed in the EP laboratory and consi sted of explanting the old device, electronic interrogation of the lead sys tem, and confirmation of defibrillation thresholds prior to implanting a ne w device. Local anesthesia was provided by lidocaine infiltration and sedat ion was achieved with intravenous (IV) midazolam and fentanyl. Following the procedure, the patients were returned to an outpatient monito red setting for 4 hours and were then discharged. Comparisons of the health care charges for the same procedure performed in the two different setting s revealed a significant reduction in physician fees (from $3,621 +/- $556 to $2,179 +/- $577, P < 0.05), in hospital charges (from $5,811 +/- $1,102 to $2,306 +/- 696, P < 0.05), and in total charges (from $9,431 +/- $1,375 to $4,541 +/- $1,010, P < 0.05), exclusive of ICD. cost, when the procedure was performed on an outpatient basis in the EP laboratory Inpatient days a veraged 3.0 +/- 0.3 when the procedure was performed in the OR. On long-ter m follow-up there were no complications following abdominal ICD generator r eplacement in the OR (mean follow-up, 39 +/- 2 months) or in the EP laborat ory (mean follow-up, 42 +/- 4 months). Thus, ICD replacements in the EP lab oratory cost less than in the OR due to significantly lower physician fees, hospital charges, and a shorter postprocedural convalescence.