Introduction and objectives: The aim of this study was to analyze data concerning mortality, morbidity, the number of re-admissions, complications, and cost per patient after pacemaker implantation, in groups of patients with different postoperative follow-up regimens.
Patients and method: Data from 2108 patients with definitive pacemakers implanted between January, 1991 and December, 2001 were analyzed retrospectively. We took into account the length of hospital stay and pacemaker dependence: group I, non-pacemaker dependent ambulatory patients with no hospital admission (NPMD) (n=710); group II, pacemaker-dependent patients with a short hospital stay of up to 48 hours (PMD) (n=779); group III, non-pacemaker-dependent patients with routine hospitalization for more than 48 hours (NPMD) (n=289); and group IV, pacemaker-dependent patients with routine hospitalization for more than 48 hours (PMD) (n=330).
Results: Total mortality was 3.9% (n=83), and no deaths were directly related to surgery. The cause of death was cardiac in 1.4% (n=30), non-cardiac in 2.3% (n=49), and unknown in 0.2% (n=4) of the patients. Mortality was premature (<30 days) in 38 patients (1.8%) and non-premature (>30 days) in 45 patients (2.1%). Total mortality was the same in Groups I and II (0.2%), and morbidity was 0.75%, and 0.9%, respectively. There were no premature deaths in these first 2 groups. In groups III and IV, mortality rose to 1.5% and 2% and morbidity to 0.9% and 1%. The total number of re-admissions (premature and non-premature) was higher in Groups III (6 re-admissions) and IV (9 re-admissions). The average total cost per patient, considering the sum of the average unit costs of the activities in each one of the medical processes which were studied (i.e., hospitalization, home visits, surgical activity, re-admissions, and second operations) was 117 euros in group I (ambulatory surgery) and 280 euros in group II (short stay). In both groups III and IV (hospitalization) the average total cost rose to 917.80 euros.
Conclusions: Major ambulatory surgery may be an economical and efficient procedure for the health care system if it is used in carefully screened patients with cardiac stimulation.