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Same-day discharge after elective PCI safe, catching on - Medical Conferences

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Same-day discharge after elective PCI safe, catching on


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Journal
JACC: Cardiovascular Interventions
Reuters Health - 06/08/2021 - In the U.S., same-day discharge after elective percutaneous coronary intervention (PCI) has increased, with no untoward impact on patient outcomes, although the now-recommended practice varies widely among hospitals, a new analysis shows.

Using data from the CathPCI Registry, Dr. Steven M. Bradley, with the Minneapolis Heart Institute and colleagues took a cross-sectional look at more than 819,000 patients who underwent elective PCI at 1,716 hospitals from 2009 to 2017. A total of 114,461 patients (14%) went home the same day as the PCI.

The proportion of elective PCIs with same-day discharge rose more than five-fold, from 4.5% in the third-quarter of 2009 to 28.6% in the fourth quarter of 2017, the study team reports in the JACC: Cardiovascular Interventions.

"This increase in same-day discharge began prior to the implementation of reimbursement rules intended to dissuade short inpatient hospitalizations. However, the rate of increase in same-day discharge was greater following changes in reimbursement rules," Dr. Bradley and colleagues report.

Patients with same-day discharge had significantly lower angina severity, less contrast use, and were more apt to have radial access PCI.

From 2009 to 2017, the rate of same-day discharge increased from 9.9% to 39.7% for radial-access PCI and from 4.3% to 19.5% for femoral-access PCI.

There was no significant association between same-day discharge and risk-adjusted 30-day mortality among Medicare-matched patients. "These data add to the evidence suggesting that application of same-day discharge is safe as currently applied in clinical practice," the researchers say.

Yet, there was wide variation in same-day discharge between hospitals, with roughly 25% of hospitals discharging fewer than 10% of patients the same day despite the use of radial access.

"From a hospital perspective, prior studies suggest that same-day discharge is associated cost savings of between $3,000 and $6,000 per case," the study team points out.

"In light of the large hospital-level variation in same-day discharge observed in the present study, these cost savings have large implications. For every 100 elective PCI performed in 2017, hospitals in the 75th percentile of same-day discharge (41.0%) would save between $108,000 and $216,000 relative to hospitals in the 25th percentile of same-day discharge (4.5%)," they calculate.

The authors of a linked editorial say the researchers "are to be congratulated for an excellent analysis of this clinically important topic."

"With an aging population and an increasing prevalence of coronary artery disease, the demand for elective PCI is expected to rise even further. The adoption of same-day discharge for appropriate patients could make elective PCI even more patient friendly and more affordable with the resources available in the health care system in the United States and abroad," write Dr. Deepak L. Bhatt and Dr. Jonathan Sung, with Brigham and Women's Hospital Heart and Vascular Center, Boston.

"In terms of patient-centered metrics, days alive out of the hospital has emerged as one of the most popular. Assuming safety is not compromised, patients place enormous value on being at home. This important study further establishes the safety of same-day discharge and demonstrates its underuse in many centers across the country, hopefully leading to a change in practice at these centers in the near future," they conclude.

SOURCE: https://bit.ly/3xnKEsT and https://bit.ly/3fwFHYx JACC: Cardiovascular Interventions, online August 5, 2021.

By Megan Brooks



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