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Timing of ICD implantation affected adverse events
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Implantable cardioverter defibrillator implantation on a weekday morning was safer than implantation that occurred in the afternoon, evening or on a weekend or holiday.
The researchers studied 148,004 first-time ICD recipients documented in the National Cardiovascular Data Registry–ICD Registry as receiving their implants between April 2010 and March 2012. They examined the association between ICD implant start time and day of the week with complications, length of hospital stay and mortality.
Jonathan C. Hsu, MD, MAS, and colleagues found that 52.6% of implants were performed between 6 a.m. and noon, and 97.5% were performed on a weekday.
After multivariable adjustment for potential confounders, they found that ICD recipients implanted in the afternoon (noon to 5 p.m.) or evening (5 p.m. to 6 a.m.) had greater odds of experiencing any complication (OR=1.08; 95% CI, 1.01-1.15) or a hospital stay longer than 1 day (OR=1.29; 95% CI, 1.25-1.33) but similar odds of in-hospital mortality (OR=1.06; 95% CI, 0.88-1.27) compared with those implanted in the morning.
They also found that, compared with those implanted on a Tuesday, Wednesday or Thursday, patients implanted on weekends or holidays had greater odds of a hospital stay longer than 1 day (OR=1.4; 95% CI, 1.29-1.53) and a trend toward greater odds of in-hospital mortality (OR=1.52; 95% CI, 0.98-2.38) but no greater odds of experiencing any complication (OR=1.14; 95% CI, 0.96-1.36).
“Our findings may have clinical implications because ICD implantation is a nonurgent procedure that can be electively scheduled,” Hsu, from the cardiac electrophysiology section, division of cardiology, department of medicine, University of California, San Diego, and colleagues wrote. “Streamlining of operator/staff shift work and handoffs as well as developing awareness campaigns aimed at improving adverse event rates in afternoon/evening and weekend procedures may be important areas for quality improvement.”
They wrote, however, that “patients with more comorbidities or those hospitalized as an inpatient may more likely undergo ICD implantation later in the day, with preexisting illness and clinical status explaining part of the apparent association.”
Disclosure: The study was supported by the American College of Cardiology Foundation’s National Cardiovascular Data Registry. One researcher reports modest ownership in Medtronic and receiving salary support from the American College of Cardiology Foundation’s National Cardiovascular Data Registry. Another researcher reports consulting for InCardia and receiving research support from Baylis Medical, Gilead and SentreHeart.
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