Safety, Feasibility and Economic Analysis of Same Day Discharge Following Elective Percutaneous Coronary Intervention

Overview

Journal Clin Med Insights Cardiol

Publisher Sage Publications

Specialty Cardiology & Vascular Diseases

Date 2022 Sep 1

PMID 36046181

Authors

Kais Hyasat

Giuseppe Femia

Karam Alzuhairi

Andrew Ha

Joseph Kamand

Edmund Hasche

Rohan Rajaratnam

Sidney Lo

Hamid Almafragy

Kevin Liou

Joseph Chiha

Kaleab Asrress

Affiliations

Soon will be listed here.

Abstract

Background: Advances in percutaneous coronary intervention (PCI) has made the possibility of facilitating same day discharge (SDD) of patients undergoing intervention. We sought to investigate the feasibility, safety and economic impact of such a service.

Methods: We retrospectively collected data on all patients undergoing outpatient PCI at our institution over a 12-month period. We included in-hospital and 30-day major adverse cardiac events (MACE), vascular complications, acute kidney injury and any re-hospitalisations. We analysed the cost effectiveness of SDD compared to overnight admission post PCI and staged PCI following diagnostic angiography.

Results: A total of 147 patients undergoing PCI with 129 patients deemed suitable for SDD (88%). Mean age was 65.7 years. Most patients had type C lesions (60.3%); including 4 chronic total occlusions (CTOs). At 30-day follow-up there were no MACE events (0%). There were 10 (7.8%) re-hospitalisations of which majority (70%) were non cardiac presentations. We also included cost analysis for an elective PCI with SDD, which equated to $2090 per patient (total of $269 610 for cohort). Elective PCI with an overnight admission was $4440 per patient (total of $572 760 for cohort), an additional $2350 per patient (total $303 150). Total cost of an angiogram followed by a staged PCI with an overnight stay was $4700 per patient (total $606 300).

Conclusion: SDD is safe and feasible in the majority of patients that have elective coronary angiography that require PCI. SDD leads to a significant reduction in total cost and hospital stay of patients undergoing elective PCI.

Citing Articles

The Impact of Age, Comorbidities, and Discharge Timing on Clinical Outcomes Following Elective Percutaneous Coronary Intervention.

Khan F, Nawaz T, Amin M, Sajjad W, Ali H, Hussain S Cureus. 2024; 16(2):e55291.

PMID: 38558614 PMC: 10981776. DOI: 10.7759/cureus.55291.

References

Herman B . Safety of same day discharge following percutaneous coronary intervention. Heart Lung Circ. 2011; 20(6):353-6. DOI: 10.1016/j.hlc.2011.01.024. View

Shroff A, Kupfer J, Gilchrist I, Caputo R, Speiser B, Bertrand O . Same-Day Discharge After Percutaneous Coronary Intervention: Current Perspectives and Strategies for Implementation. JAMA Cardiol. 2016; 1(2):216-23. DOI: 10.1001/jamacardio.2016.0148. View

Patel M, Kim M, Karajgikar R, Kodali V, Kaplish D, Lee P . Outcomes of patients discharged the same day following percutaneous coronary intervention. JACC Cardiovasc Interv. 2010; 3(8):851-8. DOI: 10.1016/j.jcin.2010.05.010. View

Liew S, Dinh D, Liew D, Brennan A, Duffy S, Reid C . Prevalence, Outcomes and Cost Implications of Patients Undergoing Same Day Discharge After Elective Percutaneous Coronary Intervention in Australia. Heart Lung Circ. 2019; 29(8):e185-e193. DOI: 10.1016/j.hlc.2019.09.005. View

Rodriguez-Araujo G, Cilingiroglu M, Mego D, Hakeem A, Lendel V, Cawich I . Same versus next day discharge after elective transradial PCI: The RAdial SAme Day DischArge after PCI trial. (The RASADDA-PCI trial). Cardiovasc Revasc Med. 2018; 19(6S):7-11. DOI: 10.1016/j.carrev.2018.05.020. View

Abdelaal E, Rao S, Gilchrist I, Bernat I, Shroff A, Caputo R . Same-day discharge compared with overnight hospitalization after uncomplicated percutaneous coronary intervention: a systematic review and meta-analysis. JACC Cardiovasc Interv. 2013; 6(2):99-112. DOI: 10.1016/j.jcin.2012.10.008. View

Seto A, Shroff A, Abu-Fadel M, Blankenship J, Boudoulas K, Cigarroa J . Length of stay following percutaneous coronary intervention: An expert consensus document update from the society for cardiovascular angiography and interventions. Catheter Cardiovasc Interv. 2018; 92(4):717-731. DOI: 10.1002/ccd.27637. View

Jabara R, Gadesam R, Pendyala L, Chronos N, Crisco L, King S . Ambulatory discharge after transradial coronary intervention: Preliminary US single-center experience (Same-day TransRadial Intervention and Discharge Evaluation, the STRIDE Study). Am Heart J. 2008; 156(6):1141-6. DOI: 10.1016/j.ahj.2008.07.018. View

Khatri S, Webb J, Carere R, Amis A, Woolcott J, Chugh S . Safety and cost benefit of same-day discharge after percutaneous coronary intervention. Am J Cardiol. 2002; 90(4):425-7. DOI: 10.1016/s0002-9149(02)02504-3. View

10.

Rubimbura V, Rostain L, Duval A, Akakpo S, Boukantar M, Boiron P . Outcomes and safety of same-day discharge after percutaneous coronary intervention: A 10-year single-center study. Catheter Cardiovasc Interv. 2019; 94(1):105-111. DOI: 10.1002/ccd.28084. View

11.

Laarman G, Kiemeneij F, van der Wieken L, Tijssen J, Suwarganda J, Slagboom T . A pilot study of coronary angioplasty in outpatients. Br Heart J. 1994; 72(1):12-5. PMC: 1025419. DOI: 10.1136/hrt.72.1.12. View

12.

Mavromatis K . Same-day discharge after percutaneous coronary intervention: are we ready?. JACC Cardiovasc Interv. 2013; 6(2):113-4. DOI: 10.1016/j.jcin.2012.12.006. View

13.

Popescu A, Weintraub W . Outpatient percutaneous coronary interventions: hospital and health system costs saving while maintaining patient safety. JACC Cardiovasc Interv. 2010; 3(10):1020-1. DOI: 10.1016/j.jcin.2010.09.001. View

14.

Bertrand O, De LaRochelliere R, Rodes-Cabau J, Proulx G, Gleeton O, Nguyen C . A randomized study comparing same-day home discharge and abciximab bolus only to overnight hospitalization and abciximab bolus and infusion after transradial coronary stent implantation. Circulation. 2006; 114(24):2636-43. DOI: 10.1161/CIRCULATIONAHA.106.638627. View

15.

Kim M, Muntner P, Sharma S, Choi J, Stoler R, Woodward M . Assessing patient-reported outcomes and preferences for same-day discharge after percutaneous coronary intervention: results from a pilot randomized, controlled trial. Circ Cardiovasc Qual Outcomes. 2013; 6(2):186-92. DOI: 10.1161/CIRCOUTCOMES.111.000069. View

16.

Saad Y, Shugman I, Kumar M, Pauk I, Mussap C, Hopkins A . Safety and efficacy of same-day discharge following elective percutaneous coronary intervention, including evaluation of next day troponin T levels. Heart Lung Circ. 2014; 24(4):368-76. DOI: 10.1016/j.hlc.2014.11.011. View

17.

Small A, Klinke P, Della Siega A, Fretz E, Kinloch D, Mildenberger R . Day procedure intervention is safe and complication free in higher risk patients undergoing transradial angioplasty and stenting. The discharge study. Catheter Cardiovasc Interv. 2007; 70(7):907-12. DOI: 10.1002/ccd.21277. View

18.

Kiemeneij F, Laarman G, Slagboom T, van der Wieken R . Outpatient coronary stent implantation. J Am Coll Cardiol. 1997; 29(2):323-7. DOI: 10.1016/s0735-1097(96)00486-x. View

19.

Hama Amin A, Alqahtani F, Aljohani S, Farjo P, Patel K, Kawasra A . The Feasibility and Safety of Same-Day Discharge for All Comers after Elective Percutaneous Coronary Interventions. Cardiovasc Revasc Med. 2019; 21(5):588-591. PMC: 7203638. DOI: 10.1016/j.carrev.2019.09.024. View

20.

Glaser R, Gertz Z, Matthai W, Wilensky R, Weiner M, Kolansky D . Patient satisfaction is comparable to early discharge versus overnight observation after elective percutaneous coronary intervention. J Invasive Cardiol. 2009; 21(9):464-7. View