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. 2020 Mar;57(2):311-318.
doi: 10.1007/s10840-019-00673-1. Epub 2019 Dec 7.

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

Toshimasa Okabe  1 , Adrianne Miller  2 , Tanner Koppert  2 , Rafael Cavalcanti  2 , Diego Alcivar-Franco  2 , Jemina Osei  2 , Omar Kahaly  2 , Muhammad R Afzal  2 , Jaret Tyler  2 , Steven J Kalbfleisch  2 , Raul Weiss  2 , Mahmoud Houmsse  2 , Ralph S Augostini  2 , Emile G Daoud  2 , Michael J Andritsos  3 , Sujatha Bhandary  4 , Galina Dimitrova  4 , Kasey Fiorini  4 , Hamdy Elsayed-Awad  4 , Antolin Flores  4 , Leonid Gorelik  4 , Manoj H Iyer  4 , Samiya Saklayen  4 , Erica Stein  4 , Katja Turner  4 , William Perez  4 , John D Hummel  2 , Michael K Essandoh  4
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Feasibility and safety of same day subcutaneous defibrillator implantation and send home (DASH) strategy

Toshimasa Okabe et al. J Interv Card Electrophysiol. 2020 Mar.

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.

Keywords: Analgesics; Outpatient; Pain control; Same-day discharge; Subcutaneous defibrillator.

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References

    1. Heart Rhythm. 2017 Oct;14(10):1456-1463 - PubMed
    1. JAMA. 1961 Oct 21;178:261-6 - PubMed
    1. JAMA Cardiol. 2016 Nov 1;1(8):900-911 - PubMed
    1. J Am Coll Cardiol. 2018 Oct 2;72(14):e91-e220 - PubMed
    1. Anesth Analg. 1970 Nov-Dec;49(6):924-34 - PubMed

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