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When is the Best Time to Undergo an Elective Cardiac Procedure?


By Heather Buschman, PhD   |   January 13, 2015

If you could choose when to schedule a minor surgical procedure, wouldn’t you pick, say, a Saturday? That way, maybe you wouldn’t have to take as much time off from work. A new study published by the American Heart Journal suggests that might not be the best choice. Jonathan C. Hsu, MD, and colleagues found that patients undergoing an elective cardiac procedure in the afternoon or evening or on weekends or holidays were more likely to experience adverse events, such as longer hospital stays.

Hsu and colleagues sifted through a national database of cardiovascular patients to look specifically at 148,004 patients undergoing a first-time implantable cardioverter-defibrillator (ICD) implantation procedure. They found that ICD recipients implanted in the afternoon or evening experienced significantly more complications and longer hospital stays (longer than the typical one day) as compared to patients undergoing the procedure in the morning. Similarly, patients undergoing the ICD procedure on weekends or holidays also experienced significantly greater odds of spending more time in the hospital. In addition, while the difference wasn’t statistically significant, the researchers noted a trend of more in-hospital deaths among weekend/holiday ICD recipients.


ICDs are small devices implanted in the upper chest, just under the skin. The device’s wires are threaded through the chest veins and into the heart. ICDs are capable of monitoring every heartbeat for abnormally fast rhythms that could cause sudden cardiac arrest. If an abnormal rhythm is detected, the ICD is capable of pacing or shocking the heart to restore normal rhythm.

According to the researchers, poorer outcomes following procedures performed later in the day and outside normal business hours could be related to operator fatigue, physician handoffs and reduced staffing.

“What this means is that, since the ICD procedure is elective, we could mitigate risk by making more effort to schedule these procedures during the morning and regular work week. At that time, hospital staff would presumably be fresher and better prepared,” Hsu said. “And what may be even more interesting is that the same association between procedure timing and adverse events might be applicable to similar medical or surgical procedures with scheduling flexibility.”

In 2014, the UC San Diego Sulpizio Cardiovascular Center was given an “A” Hospital Safety Score by The Leapfrog Group. The A grade is based on the ability to prevent errors, injuries and infections. The score places the Sulpizio Cardiovascular Center among the safest hospitals in the U.S.

Typically, patients receive ICDs if they have advanced heart failure with poor pump function or have inherited conditions that put them at high-risk for cardiac arrhythmias and/or sudden cardiac death. The ICD helps prevent sudden cardiac arrest in these patients.

ICD implantation is a fairly common and straightforward procedure for high-risk patients, and it’s becoming even more commonplace as researchers learn more about the types of patients who would most benefit. ICD implantation is considered an “elective” procedure because it is not usually performed in an emergency situation. In other words, the procedure can be scheduled in advance.

ICD implantation takes about two to three hours to complete. Most patients stay one night in the hospital. ICD recipients are typically back to their normal activities within a few days, with some restrictions in arm movement.

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