October 4th, 2011
Is “Stent and Send” Safe for Older Patients?
Should older patients who undergo elective coronary artery stenting be sent home the same day?
Using data from the CathPCI Registry, Rao and colleagues examined outcomes in Medicare-eligible patients who underwent elective, first-time PCI. The investigators identified 107,018 patients (<11% of the million-plus older patients undergoing PCI during 2005–2008 after exclusion of those with ACS or shock and those transferred from another hospital or undergoing an urgent, emergent, or salvage procedure) and compared patients who were discharged the same day with those who were observed in the hospital overnight (see CardioExchange News blog).
What did the study authors find?
1. Only 1.3% of older patients undergoing elective PCI were discharged the same day of the procedure.
2. Compared with overnight observation, same-day discharge was not associated with an increased risk for death or readmission, either within 2 days or at 30 days after discharge.
Were the same–day-discharge and overnight-observation patients similar?
Not really. Compared with the overnight-observation patients, those discharged on the same day were more likely to have vascular closure devices and less likely to have received glycoprotein IIb/IIIa inhibitors, bivalirudin, or multivessel PCI.
The authors conclude that “selected low-risk patients may be considered for same-day discharge.”
What do you think?
Do their observational data support their conclusion?
What percentage of patients 65 years or older in your practice are low-risk and eligible for same-day discharge after PCI?
Should we be making policy decisions based on data from the CathPCI Registry (which is a voluntary, unaudited registry)?
Given that inpatient PCI in the U.S. is reimbursed at a higher rate than outpatient PCI (in-hospital observation for 23 hours or less), do you perceive a financial incentive to avoid same-day discharge in favor of hospital admission?