Feasibility and safety of same day subcutaneous defibrillator implantation and send home (DASH) strategy.

Autor: Okabe T; Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA. toshimasa.okabe@osumc.edu., Miller A; Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA., Koppert T; Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA., Cavalcanti R; Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA., Alcivar-Franco D; Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA., Osei J; Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA., Kahaly O; Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA., Afzal MR; Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA., Tyler J; Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA., Kalbfleisch SJ; Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA., Weiss R; Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA., Houmsse M; Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA., Augostini RS; Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA., Daoud EG; Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA., Andritsos MJ; Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA., Bhandary S; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Dimitrova G; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Fiorini K; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Elsayed-Awad H; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Flores A; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Gorelik L; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Iyer MH; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Saklayen S; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Stein E; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Turner K; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Perez W; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA., Hummel JD; Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA., Essandoh MK; Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
Jazyk: angličtina
Zdroj: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2020 Mar; Vol. 57 (2), pp. 311-318. Date of Electronic Publication: 2019 Dec 07.
DOI: 10.1007/s10840-019-00673-1
Abstrakt: 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.
Databáze: MEDLINE
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