Abstract 18759: Safety and Cost Effectiveness of Same Day Discharge After Elective Percutaneous Coronary Interventions: A Large Rural Single Center Experience

Abstract

Background: Stable patients (pts) undergoing an uncomplicated elective percutaneous coronary intervention (PCI) typically stay in the hospital overnight after their procedure. Many studies suggest that in carefully selected pts, discharge within hours after the PCI appears to be safe. There are no studies, however, comparing the economic impact of same day versus next day discharge. Objective: We sought to evaluate the safety and economic impact of same day discharge after an uncomplicated PCI compared with those after an overnight observation stay.. Methods: We performed a retrospective review of pts who underwent elective PCI and were discharged the same day vs. next day (from observation status) at Geisinger Medical Center between 1/1/2008 to 9/15/2013. The same-day discharge program for selected pts (“outpatient PCI”) was initiated in 2010. Guidelines for same day discharge included negative troponins at 4 hours; readiness for discharge before 8:00 pm; freedom from CHF; LVEF >40%; live within <60 miles; no impediment to obtaining immediate medical attention after discharge if needed; BMI <40, and no severe aortic regurgitation. Thirty-day outcomes were analyzed. Results: A total of 1164 elective PCI pts were identified; 280 (24%) were discharged the same day (Group 1) and 884 (76%) stayed overnight (Group 2), by physician preference. The radial route was used in 47% of pts, and increased over time. No same day discharge pts were readmitted within 24 hours. At 30 days, there were no differences between Group 1 vs. 2 in frequency of access site complications (0% vs. 0.01%), peri-procedural MI (0 % vs. 0.006%), urgent care/ED visit or readmission (0.05% vs. 0.08%) (P=NS all comparisons). Stent thrombosis and death did not occur in either group in the first 24 hr post PCI. The average charges were $67,471 for pts discharged the same day, 17% less than the $81,175 for those who spent a night being observed in the hospital (P < 0.0001). Conclusions: Same day discharge after an uncomplicated PCI and 4 hour observation period was safe and resulted in significantly reduced charges.