AMITA Health Saint Francis Hospital, Internal Medicine Residency Program, Illinois, USA.
Loma Linda University Health, Division of Cardiovascular Medicine, California, USA.
Pacing Clin Electrophysiol. 2021 Nov;44(11):1925-1933. doi: 10.1111/pace.14368. Epub 2021 Oct 6.
Due to an increasing need for cardiac implantable electronic device (CIED) placement, the cost of healthcare has been rising including the cost of hospital stay after the procedure. We conducted this systematic review and meta-analysis to assess the safety and feasibility of same-day discharge (SDD) after cardiac device implantations.
We searched MEDLINE, and Embase databases from inception to March 2021 to identify studies that compared clinical outcomes between SDD group and hospital overnight stay (HO) group after cardiac device implantations. Outcomes included complications after the procedure, mortality, and re-hospitalization. Data from each study were combined using the random-effects model to calculate pooled odds ratio (OR) with 95% confidence interval (CI).
Eight studies (one randomized control trial, three prospective cohort and four retrospective cohort studies) with a total of 61,602 patients (4153 in SDD group and 57,449 in HO group) were included. SDD was not associated with more procedure-related complications. The rates of wound problems (0.94% vs 1.84%, pooled OR = 0.86, 95%CI: 0.2-3.68, p = .834), pneumothorax (1.15% vs 0.73%, pooled OR = 1.36, 95%CI: 0.26-7.12, p = .718), hematoma (0.59% vs 2.32%, pooled OR = 0.35, 95%CI:0.01-9.85, p = .534), lead/device dislodgement (4% vs 2.48%, pooled OR = 1.71, 95%CI: 0.64-4.54, p = .281), readmission rate (17.6% vs 17.5%, pooled OR = 0.95, 95%CI: 0.74-1.21, p = .667), and mortality rate (1.66% vs 1.44%, pooled OR = 0.77, 95%CI: 0.58-1.01, p = .059) were similar between in SDD and HO groups respectively.
Our meta-analysis suggested that SDD after cardiac device implantations might be a safe and feasible alternative to HO without differences in procedure-related complications, readmission rates, or mortality rates.
由于对心脏植入式电子设备（CIED）的需求不断增加，医疗保健成本一直在上升，包括手术后的住院费用。我们进行了这项系统评价和荟萃分析，以评估心脏设备植入后当天出院（SDD）的安全性和可行性。
我们检索了 MEDLINE 和 Embase 数据库，从建库到 2021 年 3 月，以确定比较心脏设备植入后 SDD 组和医院过夜（HO）组临床结局的研究。结局包括手术后并发症、死亡率和再入院率。使用随机效应模型对每项研究的数据进行合并，以计算合并的优势比（OR）及其 95%置信区间（CI）。
共纳入 8 项研究（1 项随机对照试验、3 项前瞻性队列研究和 4 项回顾性队列研究），共 61602 例患者（SDD 组 4153 例，HO 组 57449 例）。SDD 与更多的手术相关并发症无关。伤口问题的发生率（0.94%比 1.84%，合并 OR=0.86，95%CI：0.2-3.68，p=0.834）、气胸（1.15%比 0.73%，合并 OR=1.36，95%CI：0.26-7.12，p=0.718）、血肿（0.59%比 2.32%，合并 OR=0.35，95%CI：0.01-9.85，p=0.534）、导联/器械移位（4%比 2.48%，合并 OR=1.71，95%CI：0.64-4.54，p=0.281）、再入院率（17.6%比 17.5%，合并 OR=0.95，95%CI：0.74-1.21，p=0.667）和死亡率（1.66%比 1.44%，合并 OR=0.77，95%CI：0.58-1.01，p=0.059）在 SDD 和 HO 组之间相似。
我们的荟萃分析表明，心脏设备植入后 SDD 可能是一种安全可行的替代 HO 的方法，在手术相关并发症、再入院率或死亡率方面没有差异。
