Implantation of permanent pacemakers in the electrophysiology laboratory: What it has changed in a general teaching hospital

BACKGROUND: Analysis of surveys concerning current practice in pacemaker im plantation has shown a difference between the United Stales and Canada: alm ost 70% of pacemakers are im planted in the operating room (OR) by surgeons in Canada, while in the United Stales, 70% of the implantations are done i n a catheterization laboratory. OBJECTIVE: To analyze the impact (in terms of complications, time on the wa iting list, length of hospitalization and costs) of moving surgery from the OR to the electrophysiology laboratory (EPL) in a 450-bed Canadian teachin g hospital. Data were collected on 100 consecutive implantations in the OR and, subsequently, on 100 procedures in the EPL. RESULTS: The populations were identical in age (68+/-18 and 69+/-18 years, respectively) and se?: ratio (both groups were 58% male). The implantation technique differed: the subclavian approach was used in 73% of patients in the OR group and in 99% of those in the EPL group. Antibiotic prophylaxis w as given to all patients. The dual chamber rate was 22% in the OR group and 28% in the EPL group. Complication rates were similar in the two groups. E leven per cent of procedures in the OR group and 46% in the EPL group were elective, For patients who underwent nonelective surgery, the time from ind ication to implantation was reduced from 3.3+/-2.6 days in the OR group to 1.9+/-1.8 days in the EPL group (P=0.0005), and the total stay in hospital was 10.2+/-1.4 days and 6.9+/-7.8 days, respectively (P=0.01). For both ele ctive and nonelective surgery, the total stay in hospital was 9.2+/-7.4 day s in the OR group and 4.2+/-6.4 days in the EPL group (P<0.00001). The over all cost reduction, taking into account an arbitrary earlier discharge in t he EPL group, was almost 50%. CONCLUSIONS: In this general teaching hospital, moving pacemaker implantati on surgery from the OR to the EPL was safe and reduced by almost 50% the ho spitalization stay by reducing the delay before implantation and by allowin g elective surgery.