Safety of Outpatient Implantation of the Implantable Cardioverter-defibrillator

Strategies are needed to reduce health care costs and improve patient care. The objective of our study was to analyze the safety of outpatient implantation of cardioverter-defibrillators. A retrospective study was conducted in 401 consecutive patients who received an implantable cardioverter-defibrillator between 2007 and 2012. The rate of intervention-related complications was compared between 232 patients (58%) whose implantation was performed in the outpatient setting and 169 patients (42%) whose intervention was performed in the inpatient setting. The mean age (standard deviation) of the patients was 62 (14) years; 336 (84%) were male. Outpatients had lower left ventricular ejection fraction and a higher percentage had an indication for primary prevention of sudden death, compared to inpatients. Only 21 outpatients (9%) required subsequent hospitalization. The rate of complications until the third month postimplantation was similar for outpatients (6.0%) and inpatients (5.3%); P = .763. In multivariate analysis, only previous anticoagulant therapy was related to the presence of complications (odds ratio = 3.2; 95% confidence interval, 1.4-7.4; P < .01), mainly due to an increased rate of pocket hematomas. Each outpatient implantation saved approximately €735. Outpatient implantation of implantable cardioverter-defibrillators is safe and reduces costs. Close observation is recommended for patients receiving chronic anticoagulation therapy due to an increased risk of complications. Es importante desarrollar estrategias que reduzcan los costes sanitarios y mejoren la atención de los pacientes. El objetivo de nuestro estudio es analizar la seguridad del implante ambulatorio de desfibriladores automáticos implantables. Se estudió retrospectivamente a 401 pacientes consecutivos a los que se implantó un desfibrilador automático implantable entre 2007 y 2012. Se comparó la tasa de complicaciones relacionadas con la intervención de los 232 (58%) pacientes cuyo implante se programó como ambulatorio frente a los 169 (42%) intervenidos durante ingreso hospitalario. La media de edad era 62 ± 14 años; 336 (84%) pacientes eran varones. Los pacientes ambulatorios tuvieron, en comparación con los hospitalizados, menor fracción de eyección del ventrículo izquierdo y mayor porcentaje de indicación por prevención primaria de muerte súbita. Sólo 21 pacientes (9%) del grupo ambulatorio requirieron ingreso hospitalario. La tasa de complicaciones hasta el tercer mes tras el i