Abstract

MORENO-MILLAN, E.; GARCIA-TORRECILLAS, J.M.; VILLEGAS-DEL OJO, J.  and  PRIETO-VALDERREY, F.. Is the permanent pacemaker implant more efficient in level 1 hospital?. Med. Intensiva [online]. 2011, vol.35, n.2, pp.68-74. ISSN 0210-5691.

Objective: To determine if permanent pacemaker implants (PPM) interventions and change of generator are more efficient in small hospitals. Design: A cost-effective analysis and retrospective, cross-sectional and observational study of diagnostic related groups (DRG). Setting: The data was obtained from the national Minimum Basic Data Set (MBDS) for the year 2007 provided by the Health Ministry. Patients: This includes the total number of patients who required treatment in all national hospitals for 5 DRG: 115 - bradyarrhythmic complication during the acute coronary syndrome, heart failure or shock; 116 -symptomatic isolated conduction defects; 117 -revisions, but without changing the battery, 118- application of a new one, 549 - implementation or revision but with serious complications. Principal variables of interest: demographic, clinical (number of secondary diagnoses (NSD) and procedures (NP), mortality) and management (total and preoperative length of stay (LOS), access, discharge, hospital size), defining inefficient stays as those exceeding 2 days on the average. Results: 23,154 episodes, 5.3% small hospitals. The comparative bivariate study between small hospitals and the rest, not discriminated by DRG, showed a mean LOS of 7.87±8.78 days vs 11.01±12.95 (p=0.005, 95% CI for mean difference [0.17, 1.65]) and also lower than preoperatively (3.62±6.14 vs. 4.22±6.68 days (p=0.015)) without greater comorbidity, as measured by proxy through the NSD (5.23±2.88 vs 5.42±3.28 (p=0.055)) and NP as proxy of diagnostic and therapeutic effort (3.79±2.50 vs 3.55±2.69 (p=0.002)). A total of 24.1% were inefficient, there being an association with preoperative stay, NDS, NP and emergency access. Conclusion: Pacemaker implantation and generator change in small hospitals is more efficient, with internal consistency by subgroups.

Keywords : Pacemaker; Management; Efficiency.

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