Same-day discharge after elective PCI not associated with worse outcomes
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The proportion of patients with same-day discharge after elective PCI has increased in the past decade, and researchers for a new study found that the increase is not associated with poorer 30-day mortality or rehospitalization.
“We observed 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. These findings suggest that policy changes in reimbursement have contributed to use of same-day discharge for elective PCI and that increases in the use of same-day discharge for elective PCI have not negatively affected patient mortality and rehospitalization outcomes,” Steven M. Bradley, MD, MPH, cardiologist at Minneapolis Heart Institute and the Minneapolis Heart Institute Foundation, and colleagues wrote in JACC: Cardiovascular Interventions.
The sequential, cross-sectional analysis involved 819,091 patients who underwent elective PCI at 1,716 hospitals in the National Cardiovascular Data Registry CathPCI Registry from July 2009 to December 2017. The researchers assessed overall and hospital-level trends in same-day discharge and the association between same-day discharge and 30-day mortality and rehospitalization among 212,369 patients with linked CMS data.
Same-day discharge after elective PCI was used for 114,461 patients. The proportion of patients with same-day discharge increased over time, from 4.5% in 2009 to 28.6% in 2017. The rates of same-day discharge also increased during the study period, from 4.3% to 19.5% for patients who underwent femoral-access PCI and from 9.9% to 39.7% for patients who underwent radial access PCI.
Researchers reported consistent hospital-level variation in the use of same-day discharge (median OR for year and radial access PCI = 4.15).
Among the 212,369 patients with CMS linked data, 499 (0.2%) of patients died within 30 days. Death within 30 days occurred in 0.2% of those discharged the same day and 0.2% of those discharged the next day. There was no change in 30-day mortality over time after adjusting for risk factors. However, risk-adjusted rehospitalization decreased over time, with quicker declines among patients with same-day discharge (P < .001 for both).
“These findings suggest that increases in the use of same-day discharge for elective PCI have not negatively affected patient mortality outcomes,” the researchers wrote. “Low use of same-day discharge at some hospitals may reflect an opportunity to reduce costs of care without compromising patient outcomes.”
In an accompanying editorial, Cardiology Today Intervention Section Editor Deepak L. Bhatt, MD, MPH, executive director of interventional cardiovascular programs at Brigham and Women’s Hospital and professor of medicine at Harvard Medical School, and Jonathan G. Sung, MBChB, wrote: “There remains a crucial gap in evidence regarding the safety of same-day discharge in real-life practice among hospitals across the country.
“With an aging population and an increasing prevalence of coronary artery disease, the demand for elective PCI is expected to risk 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. ...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.”
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