Published in:
01-03-2020 | Paracetamol
Feasibility and safety of same day subcutaneous defibrillator implantation and send home (DASH) strategy
Authors:
Toshimasa Okabe, Adrianne Miller, Tanner Koppert, Rafael Cavalcanti, Diego Alcivar-Franco, Jemina Osei, Omar Kahaly, Muhammad R. Afzal, Jaret Tyler, Steven J. Kalbfleisch, Raul Weiss, Mahmoud Houmsse, Ralph S. Augostini, Emile G. Daoud, Michael J. Andritsos, Sujatha Bhandary, Galina Dimitrova, Kasey Fiorini, Hamdy Elsayed-Awad, Antolin Flores, Leonid Gorelik, Manoj H. Iyer, Samiya Saklayen, Erica Stein, Katja Turner, William Perez, John D. Hummel, Michael K Essandoh
Published in:
Journal of Interventional Cardiac Electrophysiology
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Issue 2/2020
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Abstract
Purpose
To assess the feasibility and safety of same-day discharge after S-ICD implantation by implementing a specific analgesia protocol and phone follow-up.
Methods
Consecutive patients presenting for outpatient S-ICD implantation were enrolled between 1/1/2018 and 4/30/2019. An analgesia protocol included pre-operative acetaminophen and oxycodone, intraoperative local bupivacaine, and limited use of oxycodone-acetaminophen at discharge. The primary outcome was successful same-day discharge. Numerical Pain Rating Scale (NPRS) on postoperative day (POD) 1, 3, 14, and 30 and any unplanned health care visits during the 1-month follow-up period were assessed.
Results
Out of 53 potentially eligible S-ICD patients, 49 patients (92.5%) were enrolled and successfully discharged on the same day. Mean age of these 49 patients was 47 ± 14 years. There were no acute procedural complications. Severe pain (NPRS ≥ 8) on POD 0, 1, and 3 was present in 14.3%, 14.3%, and 8.2% of patients, respectively. The total in-hospital stay was 534 ± 80 min. Four unplanned visits (8%) due to cardiac or device-related issues occurred during 1-month follow-up, including 2 patients with heart failure exacerbation, one patient with an incisional infection, and one patient with inappropriate shocks.
Conclusions
With the appropriate institutional protocol including specific analgesics and phone follow-up, same-day discharge after outpatient S-ICD implantation is feasible and appears safe for most patients.. Device-related pain can be severe in the first 3 days post-implantation and can be successfully treated with limited supply of narcotic medications.