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Prevalence and Outcomes of Same-Day Discharge After Elective Percutaneous Coronary Intervention Among Older Patients
Study Questions:
What is the prevalence and outcome of same-day discharge after percutaneous coronary intervention (PCI) in the United States?
Methods:
The authors assessed the prevalence of same-day discharge among 107,018 elderly patients undergoing elective PCI procedures at 903 sites participating in the CathPCI Registry between November 2004 and December 2008, whose outcome was linked using Medicare Part A claims. Patients with same-day discharge were compared with those with overnight stay, and the main outcome measure was death or rehospitalization occurring within 2 days and by 30 days after PCI.
Results:
The prevalence of same-day discharge was 1.25% (n = 1,339 patients) and the majority of hospitals discharged less than 3% of their patients the same day. Patient characteristics were similar between the two groups, although same-day discharge patients underwent shorter procedures with less multivessel intervention. There were no significant differences in the rates of death or rehospitalization at 2 days (same-day discharge was 0.37% vs. 0.50% in those staying overnight ) or at 30 days (9.63% vs. 9.7%). Mortality at 30 days was similar between the two groups (0.22% vs. 0.22%). The median time to death or rehospitalization was similar between the two groups (13 days vs. 14 days). After adjustment for patient and procedural characteristics, same-day discharge was not significantly associated with 30-day death or rehospitalization (adjusted odds ratio, 0.95; 95% confidence interval, 0.78-1.16).
Conclusions:
The authors concluded that same-day discharge is relatively infrequent among elderly patients undergoing contemporary elective PCI. There is no difference in the outcome of patients discharged the same day compared with those observed overnight after elective PCI.
Perspective:
Current guidelines support same-day discharge in low-risk patients undergoing elective PCI, although this is the first study to formally assess the prevalence of this practice. This study suggests that the practice is fairly uncommon and most patients are observed overnight. The outcome of patients who are discharged the same day is no different from those who are observed overnight, and most complications occur a few days after discharge. This study suggests that same-day discharge may be a reasonable strategy in carefully selected low-risk patients with good procedural outcome and adequate social support.
Keywords: Prevalence, Outcome Assessment, Health Care, Medicare Part A, Patient Discharge, United States, Percutaneous Coronary Intervention
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