[Use of suture closure systems in interventional electrophysiology : Impact on workflows, resource utilization, reimbursement, and patient safety in hospitals in the STYLE AF study].

Abstract

Background and objectives: Catheter ablation of cardiac arrhythmias is typically performed via femoral venous access. To reduce bleeding complications and shorten hospital stays, venous closure devices are gaining importance. This study aimed to quantitatively evaluate the impact of closure devices, "tagesstationär" (2 day-case stay with night leave) billing, and early recovery room (post-anesthesia care unit, PACU) discharge on economic indicators, patient-related outcomes, and staffing requirements.

Methods: Based on data from the STYLE-AF study-including PACU length of stay, groin bleeding rates, and additional outcome parameters-supplemented by expert interviews and literature review, we conducted a simulation study and real-world implementation to analyze various scenarios: use of closure devices, "tagesstationär" discharge billing, early PACU discharge, and combinations thereof. Primary endpoints were time savings in the PACU, changes in groin bleeding probability, and gains in patient comfort quantified by quality-adjusted life years (QALYs).

Results: The exclusive use of closure devices led to a 6.5% increase in case throughput and a gain of 0.0034 QALYs per patient. When combined with same-day discharge billing, the contribution margin increased by € 415 per case. Switching to same-day discharge billing without closure devices yielded a € 388.80 higher revenue per case but did not result in QALY gains or staff workload reductions. The most substantial effects were observed with the combined implementation of all measures: a 25% increase in case volume, € 661.27 higher contribution margin per patient, up to 24% relative reduction in PACU staff workload, and a QALY gain of 0.0034.

Conclusion: Closure devices, particularly when integrated with process optimizations and "tagesstationär" discharge billing, provide significant multidimensional benefits across economic performance (contribution margin), resource efficiency (PACU time), and patient outcomes (QALYs through reduced groin bleeding)-contingent on institutional context and consistent implementation.