Abstract
Clinical trial of the PPS (the prospective payment system) has begun in Japan. Our hospital (National Saitama Hospital) is a model hospital participating in this trial. Before this trial was introduced, we were attempting to shorten the length of the hospital inpatient stay after pacemaker implantation. Since screw-in leads tend to dislodge less often than tined leads, we have used them with confidence, especially in fast-track cases. Twenty-eight cases of screw-in leads and 23 cases of tined leads were compared. There were no significant differences in pacing threshold nor in sensitivity, with the exception of the operative day's pacing thresholds under a pulse width of 0.4mS. Therefore, screw-in leads were not shown to be inferior to tined leads as regards pacing characteristics. Overall, 14 patients were discharged on the first post-operative day, and 27 patients discharged within the first post-operative week thrived without post-discharge dislodgment. Also, our experience showed that the shorter hospital stay of the pacemaker implantation patients was strongly related to less expensive patient costs under the previous payment system.
