Comparaison of conventional vs same day discharge for pacemaker replacements: the START study
V Probst, A Da Costa, D Babuty, E Grandjbach, P Mondoly, L Jesel, J Mansourati, I Hebia, B Guyomarch, P Mabo, J M Dupuis, L Desprets, P Defaye, J C Deharo, J GourraudAbstract
Background
Same-day discharge (SDD) after pacemaker replacement has emerged as a potential strategy to optimize hospital resources, enhance patient satisfaction, and reduce healthcare costs. However, concerns remain regarding procedural safety and post-procedural complications compared to conventional overnight hospitalization (H).
Methods
We conducted a prospective, randomized 1/1, multicenter study including 372 consecutive patients who underwent pacemaker generator replacement between XX 2017 and XX 2023. Patients were allocated either to a same-day discharge (A group, n = 187) or a conventional hospitalization (H group, n = 185) pathway. Baseline characteristics, procedural parameters, and post-operative outcomes were systematically collected and compared between groups.
Results
Baseline characteristics were similar between the two groups. The two groups showed a comparable profile regarding pacemaker type, indication, and implantation history. The median procedure duration was 22 minutes in A versus 21 minutes in H (p = 0.84). Complication rates were low and comparable: 2.1% in A versus 1.1% in H (p = 0.69). The rate of hospitalization prolongation was 5.9% in A versus 3.8% in H (p = 0.34). The reasons for prolonged hospitalization were mostly non-medical. No significant difference was observed in reintervention or rehospitalization at 6 months (2.1% vs 2.7%, p = 0.75). Total hospitalization duration was significantly reduced in the A group (median = 0 days vs 2 days; p < 0.001). There was no increase in adverse events in the outpatient (A) group either during hospitalization or throughout follow-up; in fact, there was even a trend toward a lower incidence of more severe complications.
Conclusion
Pacemaker replacement with same-day discharge is feasible and safe in carefully selected patients. When performed under standardized protocols, this strategy ensures similar short- and mid-term outcomes compared to conventional hospitalization, while substantially reducing hospital stay and resource utilization. These results support the integration of SDD programs into routine clinical practice for device replacement.