SAFETY OF SAME DAY DISCHARGE AFTER TRANSVENOUS LEAD EXTRACTION

Background:

During the COVID-19 pandemic, patients in need of transvenous lead extraction (TLE) procedure posed a discrete problem in balancing urgent procedural needs and patient safety with limited inpatient resources. As such, the potential value for same day discharge following a lead extraction procedure, if it can be done safely, could be significant. However, no data exists about the safety of such an approach.

Methods:

All lead extraction procedures performed at Essentia Health in Duluth, MN from October 2019 through September 2021 were reviewed and data regarding demographics, procedural characteristics as well as mortality and 30-day readmissions were analyzed.

Results:

There were 64 TLE procedures completed with a total of 130 leads extracted with an average lead dwell time of 107 ± 75 months with an average of 2 ± 0 leads extracted per patient. 26 patients were discharged home the same day. The most common indication for extraction was lead or system failure in 42% of cases and to facilitate upgrade in another 41%. Mechanical extraction tools were used in 78% of cases, a laser sheath in 9% and manual traction alone in 22% of cases. 89% of patients had a pacing system reimplantation in the same procedure. The mean patient age was 68.2 ± 12.8 yrs. The 90-day mortality was 0%. There were no lead dislodgements or pneumothoraxes. The rates of unplanned 30-day readmission were similar in the same day discharge group and in the overnight stay group at 12.5% (p = 0.805). Two patients in each group were readmitted for procedure related problems within the first 30 days (p = 0.693). One patient in each group returned within 30 days for a large pocket hematoma, one patient in the same day discharge group returned on POD 3 with atrial oversensing on an integrated bipolar ICD lead a requiring lead repositioning, and one patient in the overnight stay group returned with a wound vac problem.

Conclusion:

This study demonstrates that patients undergoing transvenous lead extraction can safely be discharged home the same day in selected circumstances without an increase in procedural complications.