SAFETY OF SAME DAY DISCHARGE AFTER LEAD EXTRACTION PROCEDURES

ABSTRACT

Background: Lead extraction procedures historically involve overnight hospital observation to detect delayed manifestation of procedural complications. The need for routine hospitalization patients after uncomplicated lead extractions remains to be determined. A desire to limit hospitalization during the COVID 19 pandemic provided an opportunity to assess the appropriateness of same-day discharge (SDD) after lead extraction. Objective: To determine the appropriateness of SDD and identify characteristics that identify potential candidates for SDD in a selected cohort after lead extraction. Methods: We reviewed procedural outcomes in consecutive patients undergoing lead extraction between Jan 2020 and October 2021. Events identified as complications during the first 30 days after the procedure include death, the need for rescue cardiac/chest surgery, hemopericardium with or without tamponade, venous tear, septic embolism, hematoma or pneumothorax requiring intervention, and access-associated AV fistula. Results: One-hundred eighty-four patients, 53% women of mean age 65.6± 14 years, underwent lead extraction at our institution during the specified interval. We discharged seventy-three patients (40%) on the same day;we chose to observe another 111 (60%) in the hospital at least one night. Table 1 shows the baseline and procedural characteristics in both groups. The SDD cohort preferentially included older (68 ± 12 vs. 63.2 ± 16.7, p=0.02) patients, women (59% vs. 44%, p=0.02), those with fewer (1.4 vs. 1.9, p<0.001) leads requiring extraction, a shorter lead dwell time (3.5 ± 4.2 years vs.7.4 ± 12 years, p=0.01), and an indication for extraction other than infection (4% vs. 54%, p<0.0001). The SDD patients suffered fewer complications (0 vs. 6%, p<0.001). Complications observed in the non-SDD group include one femoral AV fistula requiring surgical intervention, three pocket hematoma, and three septic emboli causing hemodynamic instability. Four patients died from underlying sepsis during their hospitalization. Conclusion: SDD appears appropriate in selected patients following lead extraction. Women with relatively fewer leads, shorter lead dwell times, and indications other than infection appear reasonable candidates for SDD. Age alone does not identify better candidates for SDD. [Formula presented]