outpatient

Outpatient

by Loonylil - 2017-06-20 15:40:16

hi there

i don't know where you are posting from, but here in the u.k it is common to have pacemaker surgery under sedation and then go home the same day after checks and x ray to make sure the leads are in the right place

you would only stay in if there was a problem or if you didn't have anyone to be at home with you

hope this helps, I certainly found that I was glad to get into my own bed!

with best wishes ❤️

Go home as soon as possible

by IAN MC - 2017-06-20 17:00:30

I agree totally with Loonylil.  If it is a straight-forward  PM implant, it really is a relatively minor procedure .   Have the procedure done under local anaesthetic if you are given the choice and escape from the hospital as soon as possible

General anaesthesia which is usually unnecessary prolongs your recovery time and increases the time you spend in hospital . Every extra hour spent in a hospital bed greatly increases your chances of  getting a post-operative infection. Home is the best place to recover !

You don't need overnight observation. I had my PM fiitted at 11.00am and left the hosptal at 5.00 pm

Best of luck

Ian

Stay overnight if you live alone

by Michigander - 2017-06-20 22:36:22

I was given the option of staying overnight or going home on the day of surgery.  When I informed the doc that I lived alone and thought the lingering anesthetic might present a risk of falls or injury, he was quick to require the overnight observation.  I was very glad I did it.  The staff did a lot of testing on me that night.

"Outpatient" scheduling

by JoJo B - 2017-06-20 22:45:32

Hi there... I too agree with getting home, getting on with the healing in your own environment, etc, all things going well and fine... And I'm not sure why some procedures do or do not include the overnight observation. 

Just as an aside about the terminology alone, mine was scheduled as an "Outpatient" procedure even though it was also scheduled with an overnight stay for observation and testing. I understand this is more common with dual lead pacers than singles, and they perform a scan after the procedure as well as the next morning, so the doc or ep can confirm all is well and sign you out. The terminology may be used as Outpatient, with observation, for insurance purposes, as opposed to being scheduled as a multi-day inpatient procedure, as pre-authorization is not required for the "Outpatient" procedure. Just something I heard, may mean nothing at all.

I hope yours has no need for an overnight stay and observation... But, if it does, be your own best advocate and report anything that seems strange.

Also, if you do have to stay overnight, and assuming your next day chest x-ray is scheduled as soon in the morning as possible, consider Not Eating anything after midnight (hold onto your breakfast tray), just until after your film confirms that your lead(s) appear in correct placement. That way, in the rare event that you need to have a lead repositioned, you can go in for the correction as soon as they can fit you in that day, without having to wait 8 hours just because you have food in your stomach. You can always make up for a delayed meal easily... Not so fun to wait 8 hours for surgical correction just because you ate (and yes, you'll be hungry). In that event, you may stay another night, just repeat of the same process.

Best wishes for a breezy procedure and recovery!

What determines when you leave hospital ?

by IAN MC - 2017-06-21 05:03:43

Woudn't it be great if the decision was based on logic.   It seems to me that the main factors determining when you are discharged after PM implant are :-

- which country you live in

- which hospital you go to

-  the beliefs / prejudices of the individual cardiologist

Unless there are good medical reasons for keeping you in ,I do know that there are good LOGICAL reasons for getting home  a.s.a.p., ideally on the day of the implant

Ian

Inpatient/outpatient

by TBrous&Chip - 2017-06-21 06:34:41

In the U.S. inpatient/outpatient terms have become important information for patients depending on their insurance coverage.  If possible check your insurance coverage carefully before going to the hospital.  That status can change your out of pocket costs dramatically.  Once you know the correct answer talk with your doctor. Most doctors will accommodate.

I do agree with getting discharged from a hospital asap.  Lot's of very ill people there. Hospitals work hard to prevent cross infections but do not stay longer than you need.

my experience

by dwelch - 2017-06-23 02:38:33

I recently got pacer number five.  Have had a number of docs over the years, and the rule from the first doc who did the first two, was if you get a new lead you spend the night.  I am in the US have been on various health plans in a few different towns.   My assumption and talking ahead of time was because I was getting a new lead (going from a two lead to three) it was an overnight.  Brought PJs, planned for that, had a room waiting, some doc I had never met asked if I wanted to go home, I said no, that wasnt the plan, made the decision up to me and I didnt know this person from adam.  I did get an xray that probaly would not have happened, and I got at least two cant remember the term right now meds/treatments through the IV that certainly wouldnt have happened.   But yes the risk of being in a hospital was there.

Yes, outpatient is normal, certainly the replacements are, in and out same day, start to finish can be a handful or fewer hours.  As already mentioned where you live, health plans, etc drive a lot of this.  How knocked out you are, it is local, but they "give you something to calm you down", two I was awake and aware, the other three knocked out for the surgery.  Are awake pretty quick after, one they had me climb off the table, shift over to the gurney, others they moved me over, this last one I was dreaming I had been in a car wreck, woke up on the ride back to the recovery room and realized where I was, etc, so the "car wreck" was them moving me off the table to the gurney.

As someone mentioned above the xray and such, I also had a morning interrogation before I went home, which I wouldnt have had.  The xray was at oh dark thirty, 5:45 am or so, long before breakfast, and long after dinner, being on the heart floor the food is less than desireable anyway.  Dont expect to sleep at home or in the hospital, you wont get comfortable and wont be able to or want to roll over for the pain, so about an hour at a time.  but each day it gets better, I dont own a recliner maybe I would have been sleeping a full night days earlier if I had (dont sleep on my back very well so that didnt help).  If you stay then they come check your vitals every so many hours like 6, midnight, 6, noon if you are still there at noon.  first one I remember they flushed the iv port (being on the heart floor at least in the US in the places I have been they keep an IV needle in you the whole time with a cap on it so they can very quickly adminster whatever and save that time, policy for being on that floor, not something to worry about, can be annoying depending on where and how well it is placed).   If you stay they will also have a radio based monitor on you so they can watch your EKG from the nurses area, with todays tech if it goes too high or low or whatever they are there right away (guy in the room next to me), when one of my EKG monitor leads popped off they were there pretty quickly to stick it back on.

Even though the plan was for an overnight stay it was scheduled as outpatient.  I dont regret staying overnight, I just wish there had been some better communication about the plan and my real doc had talked to me instead of some stranger...I might have just gone home had the right communication happened before and during.

Again varies by country and insurance.  but from my experience the normal plan is outpatient, maybe you stay maybe you dont (new lead you stay is my experience).  Some number of days later within a week or two or three you go in and they check the incision to see it is healing right, they do an interrogation (put the wand/mouse looking thing over the device and have their oversized laptop-ish computer talk to it and print out reports for the doc, ask for your copy of the report, might resist on that might not, my body, my data is my opnion, but have not yet been challenged to that fight).  Then depending on that interrogation if they have to tweak then you get a holter for 24 hours (EKG with a recorder box) to see the new settings took place.  Generally you come back 3-6 months after that first vist post op.  And then 6-12 months and ideally 12 months between visits for the bulk of the duration of the life, as it gets close to a battery change (the whole device not just the battery) the visits may get closer together.   these days you may get a box you take home and put by/under your bed which talks to the pacer and can send data to the doc.  having/using that box (country, insurance) can affect how often they want you physically back in the office.

But short term is outpatient, maybe one night.  handful of days to a couple weeks for next visit few to 6 months for next and then you are into the long wait for the battery to run down.  the expected battery life on the report is always wrong, dont get worked up about it.  If you need adjustments they are probably in the first year, once tuned you may never need adjustments again, but YMMV.  After 30 years with a pacer I did need an adjustment on this one.  last few they just set the new one to the same settings as the old one, no issues.