Trends in Same-Day Discharge for Elective PCI

Quick Takes

  • This registry study reports a large increase in same-day discharge after PCI over the last decade and no differences in 30-day mortality following same-day or next-day discharge and no association between same-day discharge and trends in 30-day mortality.
  • However, at the hospital level, many centers infrequently provide same-day discharge following elective PCI.
  • These data suggest that low use of same-day discharge at some hospitals may reflect an opportunity to reduce costs of care without compromising patient outcomes.

Study Questions:

What are the trends and hospital variation in same-day discharge following elective percutaneous coronary intervention (PCI), and the association between trends in same-day discharge and patient outcomes?

Methods:

The investigators assessed overall and hospital-level trends in same-day discharge in a sequential cross-sectional analysis of 819,091 patients undergoing elective PCI at 1,716 hospitals in the National Cardiovascular Data Registry CathPCI Registry from July 1, 2009, to December 31, 2017. Among the 212,369 patients who linked to Centers for Medicare and Medicaid Services data, the association between same-day discharge and 30-day mortality and rehospitalization was evaluated. The authors used logistic regression to assess the association between same-day discharge and 30-day mortality with generalized estimating equations to account for within-hospital clustering.

Results:

A total of 114,461 patients (14.0%) were discharged the same day as PCI. The proportion of patients with same-day discharge increased from 4.5% in the third quarter of 2009 to 28.6% in the fourth quarter of 2017. From 2009–2017, the rate of same-day discharge increased from 4.3%–19.5% for femoral-access PCI and from 9.9%–39.7% for radial-access PCI. Hospital-level variation in the use of same-day discharge persisted throughout (median odds ratio adjusted for year and radial access, 4.15). Risk-adjusted 30-day mortality did not change over time, while risk-adjusted rehospitalization decreased over time and more quickly for same-day discharge (p for interaction < 0.001).

Conclusions:

The authors concluded that a large increase in the use of same-day discharge following elective PCI over the past decade was not associated with worse 30-day mortality or rehospitalization.

Perspective:

This registry study reports a large increase in same-day discharge after PCI over the last decade and no differences in 30-day mortality following same-day or next-day discharge and no association between same-day discharge and trends in 30-day mortality. However, at the hospital level, many centers infrequently provide same-day discharge following elective PCI. These data suggest that low use of same-day discharge at some hospitals may reflect an opportunity to reduce costs of care without compromising patient outcomes.

Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Prevention

Keywords: CathPCI Registry, Elective Surgical Procedures, Hospitalization, Length of Stay, Patient Discharge, Percutaneous Coronary Intervention, Primary Prevention, Risk


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