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

Abstract Introduction 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). Purpose To show the safety and feasibility of DS setting for any kind of generator replacement. Methods 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. Results 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). Conclusion 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