October 4th, 2011

Same-Day Discharge After PCI: Safe but Rarely Used

Same-day discharge after low-risk PCI is safe but only rarely used, according to a study published in JAMA.

Sunil Rao and colleagues analyzed data from 107,018 Medicare patients who underwent PCI at sites taking part in the CathPCI Registry. Only a small percentage (1.25%)  of patients in the study were discharged on the day of the procedure. These patients were similar to the patients with overnight stays, although same-day patients had shorter procedures, had fewer multivessel procedures, were more likely to have procedures using a transradial approach,  and were more likely to receive a vascular closure device. Same-day discharge patients also had less hypertension and dyslipidemia. In addition, they were less likely to receive GP IIb/IIIa inhibitors or bivalirudin.

Rates of death or rehospitalization at 2 days or at 30 days did not differ significantly between patients discharged on the same day and those discharged after an overnight stay:

  • 2 days: 0.37% in the same-day group and 0.50% in the overnight group (p=0.51)
  • 30 days: 9.63% and 9.70% (p=0.94).

For both groups, the median time to death or rehospitalization was almost the same (13 days in the same-day group, 14 days in the overnight group).

One “nonclinical reason” for the low rate of same-day discharge is that inpatient PCI is reimbursed at a higher rate than outpatient PCI, the authors note. The study results, they write, “suggest that a proportion of low-risk patients currently observed overnight may be eligible for same-day discharge without an increase in early or intermediate-term adverse events.”

Our Interventional Cardiology moderators, Rick Lange and David Hillis, pose some thoughtful questions about the implications of this study here. Take a look, then tell them what you think.

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