Background
Despite international growth in the use of same day percutaneous coronary intervention
(PCI), its widespread use remains limited. This study sought to determine the prevalence,
clinical outcomes and cost implications of same day discharge (SDD) amongst Australian
patients undergoing elective PCI.
Methods
This is a retrospective, observational cohort study of patients who underwent elective
PCI in Victoria between January 2014 and December 2017. Data from this study was obtained
from the Victorian Cardiac Outcomes Registry (VCOR). The primary outcome measured
was the incidence of 30-day major adverse cardiac events (MACE) and secondary outcomes
included in hospital complications and 30-day readmissions, between SDD patients and
those observed as inpatients overnight (ON). Propensity score matching for key clinical
factors were used to compare both groups.
Results
We studied 18,101 patients, with a mean age of 68±11years and 13,935 (77%) were male.
The rate of SDD was 586 (3.2%) and 17,515 (96.8%) patients stayed in hospital overnight.
Radial access was performed in 393 (67.1%) and 7,967 (45.5%) among SDD and ON patients
respectively (p<0.001). At 30 days, unplanned cardiac re-hospitalisation occurred
in 9.6% (n=56) amongst SDD and 11.6%, (n=2,033) amongst ON patients (p=0.173). Propensity
matching highlighted SDD to be non-inferior to overnight, with no significant difference
in 30-day MACE (0.5%, 95% CI: 0.34, 1.35) but SDD was associated with reduced average
length of stay by 2.06 days (95% CI: 1.94, 2.19). We observed substantial hospital
variation for SDD from 0% to 16.6% of elective PCI procedures.
Conclusions
Same day discharge after elective PCI is performed infrequently in Victoria. Despite
this, SDD appears to be safe and feasible. Given significant benefits in cost and
bed utilisation, a more consistent use of SDD could markedly improve the value of
PCI care in Australia.
Keywords
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References
- The Victorian Cardiac Outcomes Registry Annual Report 2015.Monash University, DEPM, June 2016 (Report No 3, pages 74)
- Hospital resources consumed in treating complications associated with percutaneous coronary interventions.Am J Cardiol. 2006; 97: 322-327
- Anticoagulant therapy for percutaneous coronary intervention.Circ: Cardiovasc Interv. 2010; 3: 80-88
- A single center experience with same-day transradial-PCI patients: A contrast with published guidelines.Catheter Cardiovasc Interv. 2011; 79: 583-587
- Same-day discharge compared with overnight hospitalization after uncomplicated percutaneous coronary intervention.JACC: Cardiovasc Interv. 2013; 6: 99-112
- Same-day discharge after elective percutaneous coronary interventions in Ontario, Canada.J Am Heart Assoc. 2019; 8https://doi.org/10.1161/JAHA.119.012131
- Early and late outcomes in patients excluded from same-day home discharge after transradial stenting and maximal antiplatelet therapy.Catheter Cardiovasc Interv. 2008; 72: 619-625
- Assessment of clinical outcomes related to early discharge after elective percutaneous coronary intervention.Catheter Cardiovasc Interv. 2012; 81: 6-13
- Long term outcome of elective day case percutaneous coronary intervention in patients with stable angina.Int J Cardiol. 2008; 128: 272-274
- Same-day discharge after percutaneous coronary intervention.JAMA Cardiol. 2016; 1: 216-223
- The establishment of the Victorian Cardiac Outcomes Registry (VCOR): Monitoring and optimising outcomes for cardiac patients in Victoria.Heart Lung Circ. 2018; 27: 451-463
- EQ-SD: a measure of health status from the EuroQol Group.Ann Med. 2001; 33: 337-343
- Public Hospitals Cost Report, Round 20 (Financial year 2015—16).The Independent Hospital Pricing Authority, 2019
- The Victorian Cardiac Outcomes Registry Annual Report 2017.Monash University, DEPM, August 2018 (Report No 5, pages 79)
- Early discharge compared with ordinary discharge after percutaneous coronary intervention–a systematic review and meta-analysis of safety and cost.Vasc Health Risk Manag. 2017; 13: 101-109
- Percutaneous coronary intervention in the UK: recommendations for good practice 2015.Heart. 2015; 101: 1-13
- 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.PLOS One. 2017; 12: e0169807
- Same-day discharge after percutaneous coronary intervention.J Am Coll Cardiol. 2013; 62: 275-285
- Safety and efficacy of same-day discharge following elective percutaneous coronary intervention, including evaluation of next day troponin T levels.Heart Lung Circ. 2015; 24: 368-376
- Adoption of transradial percutaneous coronary intervention and outcomes according to center radial volume in the veterans affairs healthcare system.Circ: Cardiovasc Interv. 2013; 6: 336-346
- Change in hospital-level use of transradial percutaneous coronary intervention and periprocedural outcomes: insights from the National Cardiovascular Data Registry.Circ: Cardiovasc Qual Outcomes. 2014; 7: 550-559
- Radial versus femoral approach for percutaneous coronary diagnostic and interventional procedures.J Am Coll Cardiol. 2004; 44: 349-356
- Radial access adoption in the United States -- diagnostic and interventional cardiology.([accessed 27.05.16])
- Association of same-day discharge after elective percutaneous coronary intervention in the United States with costs and outcomes.JAMA Cardiol. 2018; 3: 1041
- Prevalence and outcomes of same-day discharge after elective percutaneous coronary intervention among older patients.JAMA. 2011; 306: 1461
- Same-day discharge is feasible and safe in the majority of elderly patients undergoing elective percutaneous coronary intervention.J Invasive Cardiol. 2010; 22: 301-305
- Outcomes of patients discharged the same day following percutaneous coronary intervention.JACC: Cardiovasc Interv. 2010; 3: 851-858
- Outpatient coronary angioplasty: Feasible and safe.Catheter Cardiovasc Interv. 2005; 64: 421-427
- Outcome and safety of same-day-discharge percutaneous coronary interventions with femoral access: A single-center experience.Am Heart J. 2013; 165: 393-399
- Evolution of a same day PCI discharge program at the Launceston General Hospital.Heart Lung Circ. 2011; 20: S124
- Novel patient-centered approach to facilitate same-day discharge in patients undergoing elective percutaneous coronary intervention.J Am Heart Assoc. 2018; 7: e005733
- 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: 717-731
- Economic impact of same-day home discharge after uncomplicated transradial percutaneous coronary intervention and bolus-only abciximab regimen.JACC: Cardiovasc Interv. 2010; 3: 1011-1019
Article info
Publication history
Published online: October 16, 2019
Accepted:
September 13,
2019
Received in revised form:
July 16,
2019
Received:
April 10,
2019
Identification
Copyright
© 2019 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
