Is the permanent pacemaker implant more eficient in level 1 hospital ?

Obj ect ive: To determine if permanent pacemaker implants (PPM) intervent ions and change of generator are more eficient in small hospitals. Design: A cost -effect ive analysis and ret rospect ive, cross-sect ional and observat ional study of diagnost ic related groups (DRG). Set t ing: The data was obtained from the nat ional Minimum Basic Data Set (MBDS) for the year 2007 provided by the Health Ministry. Pat ient s: This includes t he t otal number of pat ient s who required t reatment in al l nat ional hospitals for 5 DRG: 115 bradyarrhythmic complicat ion 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 complicat ions. Principal variables of int erest : Demographic, clinical (number of secondary diagnoses (NSD) and procedures (NP), mortal it y) and management (t ot al and preoperat ive length of st ay (LOS), access, discharge, hospital size), deining ineficient stays as those exceeding 2 days on the average. Result s: 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 ineficient, there being an association with preoperative stay, NDS, NP and emergency access. Conclusion: Pacemaker implantation and generator change in small hospitals is more eficient, with internal consistency by subgroups. © 2010 Elsevier España, S.L. and SEMICYUC. All rights reserved. KEYWORDS