Same‐Day Discharge After Cardiac Device Generator Replacement: Safety and Patient Acceptability
Luigi Cocchiara, Benedetta Brescia, Mario Vaccariello, Gianluigi Comparone, Raffaele Mauriello, Lucio Addeo, Stefano Nardi, Procolo Marchese, Francesca Gennaro, Alfonso Varriale, Luigi Argenziano, Teresa Strisciuglio, Giovanni Esposito, Antonio RapacciuoloABSTRACT
Background
Same‐day discharge after cardiac implantable electronic device generator replacement may reduce hospital resource use, but evidence regarding its safety and patient acceptability remains limited. We evaluated the feasibility, safety, and patient‐reported acceptability of a day‐surgery pathway for isolated generator replacement.
Methods
We conducted a multicenter retrospective observational study of consecutive adults undergoing isolated cardiac implantable electronic device generator replacement between February 2017 and October 2024. Procedures requiring lead revision, upgrade, extraction, or repositioning were excluded. Patients were managed either through a day‐surgery pathway with same‐day discharge or through an ordinary‐setting pathway. The primary endpoint was device‐related infection within 365 days. Secondary outcomes included pocket hematoma, patient preference, and recalled preprocedural anxiety assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS) and the Anaesthesia and Surgery‐dependent Preoperative Anxiety (ASPA) scale, administered during follow‐up after the procedure. A hypothetical projection of bed‐day cost savings was also performed.
Results
A total of 416 procedures were analyzed: 216 in the day‐surgery group and 200 in the ordinary‐setting group. Within 365 days, device‐related infection occurred in 4 patients in the day‐surgery group and 5 in the ordinary‐setting group (1.9% vs. 2.5%; p = 0.743). One pocket hematoma occurred in the day‐surgery group and was managed conservatively without subsequent infection. Preference for day surgery was reported by 93.8% of evaluable patients in the day‐surgery group and 76.0% in the ordinary‐setting group (p < 0.001). Recalled preprocedural APAIS and ASPA scores were significantly lower in the day‐surgery group. Using published Italian hospital micro‐costing data as an illustrative benchmark, the 216 day‐surgery procedures corresponded to a hypothetical reduction in hospital resource consumption of approximately €159,808.
Conclusions
Same‐day discharge after isolated generator replacement was feasible and well accepted and was not associated with a detectable increase in device‐related infection within 365 days. Recalled preprocedural anxiety scores were lower among patients managed through the day‐surgery pathway, although these assessments were obtained retrospectively during follow‐up. Same‐day discharge may represent a resource‐saving organizational pathway for selected patients, but its economic impact requires assessment in a formal health‐economic analysis.