Journal of cardiothoracic and vascular anesthesia · 2026
Regional Anesthesia for Outpatient Subcutaneous Implantable Cardioverter-Defibrillator Implantation:A 5-Year Retrospective Study.
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Tyagi Abhay, Girgla Taania, Stone Alexander B, Vlassakov Kamen
Аннотация
OBJECTIVES: To evaluate whether regional anesthesia (RA) facilitates same-day discharge after outpatient subcutaneous implantable cardioverter-defibrillator (S-ICD) implantation.
DESIGN: Retrospective cohort study.
SETTING: Two quaternary-care academic medical centers.
PARTICIPANTS: Outpatients undergoing S-ICD implantation from January 2020 to December 2024.
INTERVENTIONS: Baseline demographic characteristics, perioperative variables, and outcomes were abstracted from the electronic health record. Univariate comparisons were made between patients who received RA and those who did not receive RA. Additionally, a multivariable logistic regression model estimated independent associations for same-day discharge.
MEASUREMENTS AND MAIN RESULTS: Of the 143 included outpatients, 63 received RA (RA group) and 80 did not receive RA (no RA group). Same-day discharge occurred more often in the RA group than in the no RA group (45 [71%] v 36 [45%], p = 0.002). Patients who received RA needed fewer airway interventions such as supraglottic airway or endotracheal intubation (13 [20.6%] v 70 [87.5%], p < 0.001), had lower intraprocedural heart rate (HR) variability (median difference between maximum and minimum intraoperative HR [interquartile range (IQR)], 25 bpm [18-33] v 40 bpm [27-48]; p < 0.001), had lower mean arterial pressure (MAP) variability (mean difference between maximum and minimum intraoperative MAP [95% confidence interval (CI)], 41.1 mm Hg [11.9-30.3] v 45.6 mm Hg [10.4-81]; p = 0.07)], and required less vasopressor administration (34 patients v 71 patients, p < 0.001). After the procedure, the RA group had a shorter recovery time (235 minutes v 284 minutes, p = 0.016) and lower postoperative opioid requirements (median [IQR], 0 mg [0-10 mg] v 7.5 mg [0-22.5 mg]; p = 0.003). In multivariable logistic regression analysis, RA was associated with higher odds of same-day discharge (adjusted odds ratio, 3.27; 95% CI, 1.07-9.73) whereas advancing age and afternoon start time were associated with lower odds of same-day discharge.
CONCLUSIONS: In outpatient S-ICD implantation, RA was associated with a higher likelihood of same-day discharge, lower periprocedural opioid requirements, reduced intraprocedural vasopressor use, and less HR variability. These findings suggest that RA may support perioperative efficiency in selected patients undergoing outpatient S-ICD implantation.
DESIGN: Retrospective cohort study.
SETTING: Two quaternary-care academic medical centers.
PARTICIPANTS: Outpatients undergoing S-ICD implantation from January 2020 to December 2024.
INTERVENTIONS: Baseline demographic characteristics, perioperative variables, and outcomes were abstracted from the electronic health record. Univariate comparisons were made between patients who received RA and those who did not receive RA. Additionally, a multivariable logistic regression model estimated independent associations for same-day discharge.
MEASUREMENTS AND MAIN RESULTS: Of the 143 included outpatients, 63 received RA (RA group) and 80 did not receive RA (no RA group). Same-day discharge occurred more often in the RA group than in the no RA group (45 [71%] v 36 [45%], p = 0.002). Patients who received RA needed fewer airway interventions such as supraglottic airway or endotracheal intubation (13 [20.6%] v 70 [87.5%], p < 0.001), had lower intraprocedural heart rate (HR) variability (median difference between maximum and minimum intraoperative HR [interquartile range (IQR)], 25 bpm [18-33] v 40 bpm [27-48]; p < 0.001), had lower mean arterial pressure (MAP) variability (mean difference between maximum and minimum intraoperative MAP [95% confidence interval (CI)], 41.1 mm Hg [11.9-30.3] v 45.6 mm Hg [10.4-81]; p = 0.07)], and required less vasopressor administration (34 patients v 71 patients, p < 0.001). After the procedure, the RA group had a shorter recovery time (235 minutes v 284 minutes, p = 0.016) and lower postoperative opioid requirements (median [IQR], 0 mg [0-10 mg] v 7.5 mg [0-22.5 mg]; p = 0.003). In multivariable logistic regression analysis, RA was associated with higher odds of same-day discharge (adjusted odds ratio, 3.27; 95% CI, 1.07-9.73) whereas advancing age and afternoon start time were associated with lower odds of same-day discharge.
CONCLUSIONS: In outpatient S-ICD implantation, RA was associated with a higher likelihood of same-day discharge, lower periprocedural opioid requirements, reduced intraprocedural vasopressor use, and less HR variability. These findings suggest that RA may support perioperative efficiency in selected patients undergoing outpatient S-ICD implantation.