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

Abstract

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.

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

“…Our study builds on and extends an accumulating body of evidence showing that SDD is safe and associated with lower costs of care. Two recent meta‐analyses of randomized controlled trials of SDD have confirmed the safety of SDD in terms of adverse events, such as mortality, myocardial infarction, major bleeding, blood transfusion, repeated revascularization, and rehospitalization; these adverse events were not significantly different between SDD and overnight stay groups, up to 30 days after PCI 3, 32. In the current climate of healthcare reform, lower costs of care offer a tremendous competitive advantage to hospitals.…”

“…Two recent meta-analyses of randomized controlled trials of SDD have confirmed the safety of SDD in terms of adverse events, such as mortality, myocardial infarction, major bleeding, blood transfusion, repeated revascularization, and rehospitalization; these adverse events were not significantly different between SDD and overnight stay groups, up to 30 days after PCI. 3,32 In the current climate of healthcare reform, lower costs of care offer a tremendous competitive advantage to hospitals. There is a constant and increasing pressure on the US healthcare system to reduce costs of care, and hospitals are increasingly challenged to deliver higher-quality care at lower costs.…”

Association of Same-Day Discharge After Elective Percutaneous Coronary Intervention in the United States With Costs and Outcomes

“…While complications are generally rare after elective PCI, when they do occur, they usually do so in the first few hours after PCI, facilitating the identification of patients who are unsafe for SDD. 3,4,8,[18][19][20] The practice of overnight observation for all patients after elective PCI for the concern for patient safety is not evidence based. Several randomized clinical trials have confirmed the safety of SDD vs NSDD.…”

Increased pulse wave transit time after percutaneous coronary intervention procedure in CAD patients

“…Bundhun et al . have found that there are no significant differences in adverse outcomes between same day discharge and overnight hospital stay 8 . Therefore, a better explanation of the changes in PWTT of CAD patients, especially between before and after PCI, is helpful to understand the effectiveness of PCI.…”