Same-Day Discharge Compared With Overnight Hospitalization After Uncomplicated Percutaneous Coronary Intervention

Abdelaal, Eltigani; Rao, Sunil V.; Gilchrist, Ian C.; Bernát, Ivo; Shroff, Adhir; Caputo, Ronald P.; Costerousse, Olivier; Pancholy, Samir; Bertrand, Olivier

doi:10.1016/j.jcin.2012.10.008

Cited by 105 publications

(53 citation statements)

References 41 publications

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“…Similar to this analysis, Abdelaal et al [16] who evaluated the outcomes of same day discharge versus overnight hospitalization following PCI showed similar rate of MACEs associated with both discharge strategies and it should be noted that their analysis included a large number of patients (110,000 patients) obtained from observational studies and randomized trials. Brayton et al [17] also showed that in selected patients undergoing PCI, same day discharge was not associated with a higher rate of major adverse events and this strategy appeared to be as safe as the overnight following coronary angioplasty.…”

Section: Discussionmentioning

confidence: 55%

Same Day Discharge versus Overnight Stay in the Hospital following Percutaneous Coronary Intervention in Patients with Stable Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2017

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BackgroundNew research in interventional cardiology has shown the demand for percutaneous coronary interventions (PCI) to have increased tremendously. Effective treatment with a lower hospital cost has been the aim of several PCI capable centers. This study aimed to compare the adverse clinical outcomes associated with same day discharge versus overnight stay in the hospital following PCI in a population of randomized patients with stable coronary artery disease (CAD).MethodsThe National Library of Medicine (MEDLINE/PubMed), the Cochrane Registry of Randomized Controlled Trials and EMBASE databases were searched (from March to June 2016) for randomized trials comparing same-day discharge versus overnight stay in the hospital following PCI. Main endpoints in this analysis included adverse cardiovascular outcomes observed during a 30-day period. Statistical analysis was carried out by the RevMan 5.3 software whereby odds ratios (OR) and 95% confidence intervals (CIs) were calculated with respect to a fixed or a random effects model.ResultsEight randomized trials with a total number of 3081 patients (1598 patients who were discharged on the same day and 1483 patients who stayed overnight in the hospital) were included. Results of this analysis showed that mortality, myocardial infarction (MI) and major adverse cardiac events (MACEs) were not significantly different between same day discharge versus overnight stay following PCI with OR: 0.22, 95% CI: 0.04–1.35; P = 0.10, OR: 0.68, 95% CI: 0.33–1.41; P = 0.30 and OR: 0.45, 95% CI: 0.20–1.02; P = 0.06 respectively. Blood transfusion and re-hospitalization were also not significantly different between these two groups with OR: 0.64, 95% CI: 0.13–3.21; P = 0.59 and OR: 1.53, 95% CI: 0.88–2.65; P = 0.13 respectively. Similarly, any adverse event, major bleeding and repeated revascularization were also not significantly different between these two groups of patients with stable CAD, with OR: 0.42, 95% CI: 0.05–3.97; P = 0.45, OR: 0.73, 95% CI: 0.15–3.54; P = 0.69 and OR: 0.67, 95% CI: 0.14–3.15; P = 0.61 respectively.ConclusionIn terms of adverse cardiovascular outcomes, same day discharge was neither superior nor inferior to overnight hospital stay following PCI in those patients with stable CAD. However, future research will have to emphasize on the long-term consequences.

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Section: Discussionmentioning

confidence: 55%

Same Day Discharge versus Overnight Stay in the Hospital following Percutaneous Coronary Intervention in Patients with Stable Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

2017

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“…Three systematic reviews and meta-analyses have been performed to assess differences between SDD and overnight observation from randomized trials alone [19,20] and randomized trials plus observational studies [3]. Each of these analyses demonstrated no difference in acute or medium-term mortality, myocardial infarction and MACE between groups (Figure 2).…”

Section: P R a Cti Ce E Vol U Ti Onmentioning

confidence: 99%

“…Since the publication of the 2009 document, PCI practice has continued to evolve and rates of postprocedural complications have declined. In addition, studies have demonstrated the safety of sameday discharge (SDD) in patients undergoing PCI [2,3]. Many patients prefer to recover from a PCI procedure at home rather than spend a night in the hospital [4].…”

Section: B Ac Kgr Ound /Introductionmentioning

confidence: 99%

Length of stay following percutaneous coronary intervention: An expert consensus document update from the society for cardiovascular angiography and interventions

Seto

Shroff

Abu‐Fadel

et al. 2018

Cathet Cardio Intervent

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Since the publication of the 2009 SCAI Expert Consensus Document on Length of Stay Following percutaneous coronary intervention (PCI), advances in vascular access techniques, stent technology, and antiplatelet pharmacology have facilitated changes in discharge patterns following PCI. Additional clinical studies have demonstrated the safety of early and same day discharge in selected patients with uncomplicated PCI, while reimbursement policies have discouraged unnecessary hospitalization. This consensus update: (1) clarifies clinical and reimbursement definitions of discharge strategies, (2) reviews the technological advances and literature supporting reduced hospitalization duration and risk assessment, and (3) describes changes to the consensus recommendations on length of stay following PCI (Supporting Information Table S1). These recommendations are intended to support reasonable clinical decision making regarding postprocedure length of stay for a broad spectrum of patients undergoing PCI, rather than prescribing a specific period of observation for individual patients.

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“…However, what defines “carefully selected” elective PCI patients has been inconsistently applied, if defined at all 2, 3, 4, 5, 6, 7, 8, 9. Some studies have cautiously explored the feasibility of SDD beyond the low‐risk population,7, 10, 11, 12, 13, 14 but they were evaluated in selected patients or required protocols or checklists.…”

mentioning

confidence: 99%

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

Amin

Crimmins‐Reda

Miller

et al. 2018

JAHA

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BackgroundSame‐day discharge (SDD) after elective percutaneous coronary intervention is safe, less costly, and preferred by patients, but it is usually performed in low‐risk patients, if at all. To increase the appropriate use of SDD in more complex patients, we implemented a “patient‐centered” protocol based on risk of complications at Barnes‐Jewish Hospital.Methods and ResultsOur objectives were as follows: (1) to evaluate time trends in SDD; (2) to compare (a) mortality, bleeding, and acute kidney injury, (b) patient satisfaction, and (c) hospital costs by SDD versus no SDD (NSDD); and (3) to compare SDD eligibility by our patient‐centered approach versus Society for Cardiovascular Angiography and Interventions guidelines. Our patient‐centered approach was based on prospectively identifying personalized bleeding, mortality, and acute kidney injury risks, with a personalized safe contrast limit and mitigating those risks. We analyzed Barnes‐Jewish Hospital's National Cardiovascular Data Registry CathPCI Registry data from July 1, 2009 to September 30, 2015 (N=1752). SDD increased rapidly from 0% to 77% (P<0.001), independent of radial access. Although SDD patients were comparable to NSDD patients, SDD was not associated with adverse outcomes (0% mortality, 0% bleeds, and 0.4% acute kidney injury). Patient satisfaction was high with SDD. Propensity score–adjusted costs were $7331 lower/SDD patient (P<0.001), saving an estimated $1.8 million annually. Only 16 patients (6.95%) met the eligibility for SDD by Society for Cardiovascular Angiography and Interventions guidelines, implying our patient‐centered approach markedly increased SDD eligibility.ConclusionsWith a patient‐centered approach, SDD rapidly increased and was safe in 75% of patients undergoing elective percutaneous coronary intervention, despite patient complexity. Patient satisfaction was high, and hospital costs were lower. Patient‐centered decision making to facilitate SDD is an important opportunity to improve the value of percutaneous coronary intervention.

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Same-Day Discharge Compared With Overnight Hospitalization After Uncomplicated Percutaneous Coronary Intervention

Cited by 105 publications

References 41 publications

Same Day Discharge versus Overnight Stay in the Hospital following Percutaneous Coronary Intervention in Patients with Stable Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Same Day Discharge versus Overnight Stay in the Hospital following Percutaneous Coronary Intervention in Patients with Stable Coronary Artery Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Length of stay following percutaneous coronary intervention: An expert consensus document update from the society for cardiovascular angiography and interventions

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

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