CIED replacement optimization: feasibility, safety and acceptability of day surgery setting for CIED replacement

Cardiac implantable electronic device (CIED) replacement, mainly due to battery depletion[1], has become a pivotal aspect of activity in leading implant centers [2]. The complication rate significantly exceeds that of initial implantation [3]. Day surgery setting (DS) represents an emerging option in interventional cardiology compared with ordinary setting (OS), but the lack of studies regarding this setting leads to a gap in literature especially regarding complex devices (i.e. CRT-D or S-ICD).

To show the safety and feasibility of DS setting for any kind of generator replacement.

This is a retrospective observational, single center study of patients receiving CIED replacement between 2017 and 2024, which enrolled 208 patients. The cohort was divided into two groups: one underwent replacement in DS setting (125 patients) and one in OS (83 patients). We analyzed the safety of DS approach evaluating the infection rate at 1 year. We analized patients’ satisfaction with a questionnaire developed by our department and with The Amsterdam Preoperative Anxiety and Information Scale (APAIS) and The Anesthesia and Surgery dependent Preoperative Anxiety (ASPA) questionnaire.

Patients enrolled were 208 (66% male, 76 [25-97] years). Complex devices were 23% (1 CRT-P, 40 CRT-D, 6 S-ICD). Infection rate was 1,6% (n=2) in DS group and 2,4%(n=2) in OS group (p=0.677). Patients’ preference was found to be, in the DS group, 88,8%(n=111) for DS setting and 5,6%(n=7) for ordinary setting whereas, in OS group, 65,1%(n=54) preferred DS setting and 28,9%(n=24) preferred OS setting (p= <0.001).

The day surgery setting is safe for patients undergoing any type of generator replacement, including complex ones. Our data suggests that shifting to a same-day discharge leads to higher levels of satisfaction and lower levels of preoperative anxiety and stress, with a reduction in the number of hospital bed-days and economic benefits for the healthcare system.

Graphical Abstract