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  • Title: Implantation of permanent pacemakers in the electrophysiology laboratory: what it has changed in a general teaching hospital.
    Author: Molin F, Pagé P, Daoust L.
    Journal: Can J Cardiol; 2000 Jul; 16(7):871-5. PubMed ID: 10934305.
    Abstract:
    BACKGROUND: Analysis of surveys concerning current practice in pacemaker implantation has shown a difference between the United States and Canada: almost 70% of pacemakers are implanted in the operating room (OR) by surgeons in Canada, while in the United States, 70% of the implantations are done in a catheterization laboratory. OBJECTIVE: To analyze the impact (in terms of complications, time on the waiting list, length of hospitalization and costs) of moving surgery from the OR to the electrophysiology laboratory (EPL) in a 450-bed Canadian teaching 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 sex 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 was 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. Eleven 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 indication 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+/-7.4 days and 6.9+/-7.8 days, respectively (P=0. 01). For both elective and nonelective surgery, the total stay in hospital was 9.2+/-7.4 days in the OR group and 4.2+/-6.4 days in the EPL group (P<0.00001). The overall cost reduction, taking into account an arbitrary earlier discharge in the EPL group, was almost 50%. CONCLUSIONS: In this general teaching hospital, moving pacemaker implantation surgery from the OR to the EPL was safe and reduced by almost 50% the hospitalization stay by reducing the delay before implantation and by allowing elective surgery.
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