B-PO04-144 SAFETY AND FEASIBILITY OF SAME DAY DISCHARGE AFTER PERCUTANEOUS LEFT ATRIAL APPENDAGE OCCLUSION

Abstract

The Watchman (Boston Scientific) left atrial appendage occlusion (LAAO) procedure is approved by CMS as an in-patient procedure that typically requires overnight hospitalization. In order to preserve hospital capacity during the COVID-19 pandemic, we employed a same day discharge (SDD) protocol strategy for selected patients undergoing percutaneous LAAO. To assess the feasibility and safety of SDD after Watchman procedure. We retrospectively evaluated patients that received a Watchman device at Emory Healthcare from January 1st to December 31st 2020. We performed a chart review to collect patient baseline characteristics and procedural outcomes including procedural success defined as successful occlusion with <5mm peri-device leak, 30-day complications, and 30-day readmissions. We compared SDD patients to those who stayed at least one night in the hospital post-procedure (Overnight Stay [OS] group). The cohort included 143 patients with a mean age of 75.8 ± 7.3 years and CHA2DS2-VASc 4.6 ± 1.4, of whom 60 patients were in the SDD group and 83 were in the OS group. The mean length of stay was 1.2 ± 0.7 nights in the OS group. There were 5 complications in the entire cohort, all of which occurred in the OS group: SDD 0/60 and OS 5/83(p=0.07). The complications were related to femoral vascular access (2), cardiac tamponade (1) (which was successfully percutaneously drained), respiratory insufficiency requiring prolonged hospitalization (1), and a sudden death that occurred 25 days post-procedure (1). There were seven readmissions within 30 days, with a similar rate in the SDD (2/60) and OS (5/83) groups. There were 5 peri-device leaks (3.5%) greater than 5 mm on 45-day follow-up imaging, without significant difference between groups: SDD 2/35 and OS 3/47. Same day discharge following percutaneous LAAO is associated with similar outcomes compared to overnight stay in appropriately selected patients. The trend to higher complication rates in the OS group is likely related to patient selection characteristics.