Same-day discharge after elective PCI has increased value and patient satisfaction

Background: SDDs are as safe as non-SDDs (NSDDs) in patients after elective PCI, yet there has been only a modest increase in SDD.

Study design: Observational cross-sectional cohort study.

Setting: 493 hospitals in the United States.

Synopsis: With use of the national Premier Healthcare Database, 672,470 elective PCIs from January 2006 to December 2015 with 1-year follow-up showed a wide variation in SDD from 0% to 83% among hospitals with the overall corrected rate of 3.5%. Low-volume PCI hospitals did not increase the rate. Additionally, the cost of SDD patients was $5,128 less than NSDD patients. There was cost saving even with higher-risk transfemoral approaches and patients needing periprocedural hemodynamic or ventilatory support. Complications (death, bleeding, acute kidney injury, or acute MI at 30, 90, and 365 days) were not higher for SDD than for NSDD patients.

Limitations include that 2015 data may not reflect current practices. ICD 9 codes used for obtaining complications data can be misclassified. Cost savings are variable. Patients with periprocedural complications were not candidates for SDD but were included in the data. The study does not account for variation in technique, PCI characteristics, or SDD criteria of hospitals.

Bottom line: Prevalence of SDDs for elective PCI patients varies by institution and is an underutilized opportunity to significantly reduce hospital costs and increase patient satisfaction while maintaining the safety of patients.

Citation: Amin AP et al. Association of same-day discharge after elective percutaneous coronary intervention in the United States with costs and outcomes. JAMA Cardiol. Published online 2018 Sep 26. doi: 10.1001/jamacardio.2018.3029.

Dr. Kochar is an assistant professor of medicine in the division of hospital medicine at Mount Sinai Hospital, New York.

Background: SDDs are as safe as non-SDDs (NSDDs) in patients after elective PCI, yet there has been only a modest increase in SDD.

Study design: Observational cross-sectional cohort study.

Setting: 493 hospitals in the United States.

Synopsis: With use of the national Premier Healthcare Database, 672,470 elective PCIs from January 2006 to December 2015 with 1-year follow-up showed a wide variation in SDD from 0% to 83% among hospitals with the overall corrected rate of 3.5%. Low-volume PCI hospitals did not increase the rate. Additionally, the cost of SDD patients was $5,128 less than NSDD patients. There was cost saving even with higher-risk transfemoral approaches and patients needing periprocedural hemodynamic or ventilatory support. Complications (death, bleeding, acute kidney injury, or acute MI at 30, 90, and 365 days) were not higher for SDD than for NSDD patients.

Limitations include that 2015 data may not reflect current practices. ICD 9 codes used for obtaining complications data can be misclassified. Cost savings are variable. Patients with periprocedural complications were not candidates for SDD but were included in the data. The study does not account for variation in technique, PCI characteristics, or SDD criteria of hospitals.

Bottom line: Prevalence of SDDs for elective PCI patients varies by institution and is an underutilized opportunity to significantly reduce hospital costs and increase patient satisfaction while maintaining the safety of patients.

Citation: Amin AP et al. Association of same-day discharge after elective percutaneous coronary intervention in the United States with costs and outcomes. JAMA Cardiol. Published online 2018 Sep 26. doi: 10.1001/jamacardio.2018.3029.

Dr. Kochar is an assistant professor of medicine in the division of hospital medicine at Mount Sinai Hospital, New York.

Background: SDDs are as safe as non-SDDs (NSDDs) in patients after elective PCI, yet there has been only a modest increase in SDD.

Study design: Observational cross-sectional cohort study.

Setting: 493 hospitals in the United States.

Synopsis: With use of the national Premier Healthcare Database, 672,470 elective PCIs from January 2006 to December 2015 with 1-year follow-up showed a wide variation in SDD from 0% to 83% among hospitals with the overall corrected rate of 3.5%. Low-volume PCI hospitals did not increase the rate. Additionally, the cost of SDD patients was $5,128 less than NSDD patients. There was cost saving even with higher-risk transfemoral approaches and patients needing periprocedural hemodynamic or ventilatory support. Complications (death, bleeding, acute kidney injury, or acute MI at 30, 90, and 365 days) were not higher for SDD than for NSDD patients.

Limitations include that 2015 data may not reflect current practices. ICD 9 codes used for obtaining complications data can be misclassified. Cost savings are variable. Patients with periprocedural complications were not candidates for SDD but were included in the data. The study does not account for variation in technique, PCI characteristics, or SDD criteria of hospitals.

Bottom line: Prevalence of SDDs for elective PCI patients varies by institution and is an underutilized opportunity to significantly reduce hospital costs and increase patient satisfaction while maintaining the safety of patients.

Citation: Amin AP et al. Association of same-day discharge after elective percutaneous coronary intervention in the United States with costs and outcomes. JAMA Cardiol. Published online 2018 Sep 26. doi: 10.1001/jamacardio.2018.3029.

Dr. Kochar is an assistant professor of medicine in the division of hospital medicine at Mount Sinai Hospital, New York.