Implantation of a cardiac pacemaker - comparison of subjective stress and mood between in- and outpatients.

BACKGROUND: An increasing number of cardiac pacemaker implantations are performed in the outpatient setting. Studies have compared costs and complication rates of outpatient versus inpatient pacemaker implantations but little is known on the subjective experience of the procedure by patients. METHODS: Between 1999 and 2000, patients were prospectively included at admission to a teaching hospital and to an outpatient clinic for elective pacemaker implantations in Cottbus, Germany. Perioperative stress was assessed prior to the operation as well as on the day after the implantation and 3-4 days later. We used three validated questionnaires to assess stress: the "Short Questionnaire of Current Stress", the "Multidimensional Mood Questionnaire", and the "List of Mood and Emotion Descriptors". RESULTS: A total of 138 patients were enrolled. Of those, 74 patients (mean age: 71+/-12 years; 45% female) had an outpatient implantation compared to 64 patients in the hospital setting (mean age: 73+/-12 years; 53% female). Stress was highest immediately prior to the implantation and lowest on day 3-4 in both groups. Inpatients were significantly less likely to experience agitation compared to outpatients (P=0.002). On the other hand, outpatients reported a significantly higher activity level. There were no differences regarding any of the other dimensions between the two groups. CONCLUSION: Both in- and outpatient cardiac pacemaker implantation are associated with increased preoperative stress. In both groups, however, stress decreases rapidly following the intervention. In the referral of patients, sociodemographic factors such as area of residence will probably play the key role.