A new meta-analysis, published on Jan. 23 in the JACC CV Interventions, reports that same-day discharge (SDD) of patients following uncomplicated, elective percutaneous coronary intervention (PCI) is a reasonable strategy for selected patients.

Additional Resources Full Study Journal Scan  2011 Guideline for PCI 2012 AUC for Coronary Revascularization

The study pooled data from five randomized and eight observational studies comparing SDD and overnight hospitalization (ON) in 111,830 patients who underwent PCI. Results showed for total complications, the strategy of SDD compared with ON after PCI had an estimated odds ratio (OR) of 1.20 (95 percent CI: 0.82 to 1.74) in randomized and 0.67 (95 percent CI: 0.27 to 1.66) in observational studies. Similar results were found for major adverse cardiac events (randomized, OR: 0.99, 95 percent CI: 0.45 to 218; observational, OR: 0.59, 95 percent CI: 0.06 to 5.57) and rehospitalizations (randomized, OR: 1.10, 95 percent CI: 0.70 to 1.74; observational, OR: 0.62, 95 percent CI: 0.10 to 3.98) at 30 days post-PCI.

The investigators note that the combination of "low event rate and wide corresponding CIs, suggest that an adequately powered multicenter randomized trial comparing same-day discharge with overnight hospitalization would require a very large sample size (>17,000). Until such a trial is completed, same-day discharge after uncomplicated PCI seems a reasonable approach in selected patients."

In an accompanying editorial, Kreton Mavromatis, MD, Atlanta Veterans Administration Medical Center, Atlanta, notes that many procedures across medical specialties are now performed on an ambulatory basis, but that the cardiology community has been slow to adopt this strategy for PCI patients.

"The slow change in the practice of coronary intervention relative to current trends in medical practice might relate to residual concerns over safety and medico-legal risk, the unrecognized cost benefit of same-day discharge and an under-appreciation of the potential for increased patient satisfaction related to avoiding an overnight stay in the hospital," he notes. "The benefits of same-day discharge lie in the potential to reduce procedural cost, increase hospital efficiency and improve patient satisfaction… [and] could potentially open up beds for other inpatient admissions in hospitals operating at near maximal capacity." He also agrees that there is a pressing need for a large-scale randomized clinical trial.

Keywords: Hospitals, Research Personnel, Patient Satisfaction, Inpatients, Patient Discharge, United States Department of Veterans Affairs, Hospitalization, Percutaneous Coronary Intervention

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