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

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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.

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Funding

Boston Scientific Corporation (Natick, MA, USA) funded the study. The funding source did not have any involvement in the study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Division of Cardiovascular Medicine, Ohio State University Wexner Medical Center, Columbus, OH, USA

    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 & John D. Hummel

  2. Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA

    Michael J. Andritsos

  3. Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Sujatha Bhandary, Galina Dimitrova, Kasey Fiorini, Hamdy Elsayed-Awad, Antolin Flores, Leonid Gorelik, Manoj H. Iyer, Samiya Saklayen, Erica Stein, Katja Turner, William Perez & Michael K Essandoh

Authors
  1. Toshimasa Okabe
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  2. Adrianne Miller
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  3. Tanner Koppert
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  4. Rafael Cavalcanti
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  5. Diego Alcivar-Franco
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  6. Jemina Osei
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  7. Omar Kahaly
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  8. Muhammad R. Afzal
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  9. Jaret Tyler
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  10. Steven J. Kalbfleisch
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  11. Raul Weiss
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  12. Mahmoud Houmsse
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  13. Ralph S. Augostini
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  14. Emile G. Daoud
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  15. Michael J. Andritsos
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  16. Sujatha Bhandary
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  17. Galina Dimitrova
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  18. Kasey Fiorini
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  19. Hamdy Elsayed-Awad
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  20. Antolin Flores
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  21. Leonid Gorelik
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  22. Manoj H. Iyer
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  23. Samiya Saklayen
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  24. Erica Stein
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  25. Katja Turner
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  26. William Perez
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  27. John D. Hummel
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  28. Michael K Essandoh
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Contributions

Conceptualization: Toshimasa Okabe, Emile G. Daoud, and Michael K Essandoh

Methodology: Toshimasa Okabe, Emile G. Daoud, and Michael K Essandoh

Data collection: Toshimasa Okabe, Adrianne Miller, Tanner Koppert, Rafael Cavalcanti, Diego Alcivar-Franco, Jemina Osei, and Omar Kahaly

Formal analysis and investigation: Toshimasa Okabe, Emile G. Daoud, Michael K Essandoh, and Muhammad R. Afzal

Writing - original draft preparation: Toshimasa Okabe, Emile G. Daoud.

Writing - review and editing: Muhammad R. Afzal, Jaret Tyler, Mahmoud Houmsse, Steven J. Kalbfleisch, Raul WeissJohn D. Hummel, Ralph S. Augostini, Sujatha Bhandary, Galina Dimitrova, Kasey Fiorini Hamdy Elsayed-Awad, Antolin Flores, MD#, Leonid Gorelik, Manoj H. Iyer, Samiya Saklayen, Erica Stein, Katja Turner, William Perez

Funding acquisition: Emile G. Daoud

Supervision: Emile G. Daoud, Michael K Essandoh, Michael J. Andritsos

Corresponding author

Correspondence to Toshimasa Okabe.

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Conflict of interest

Drs Weiss and Essandoh have received consulting fees and speaking fees from Boston Scientific. The remaining authors have no conflicts to disclose.

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Okabe, T., Miller, A., Koppert, T. et al. Feasibility and safety of same day subcutaneous defibrillator implantation and send home (DASH) strategy. J Interv Card Electrophysiol 57, 311–318 (2020). https://doi.org/10.1007/s10840-019-00673-1

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  • DOI: https://doi.org/10.1007/s10840-019-00673-1

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