Safety and Cost Implications of Same-Day Discharge Following Elective Percutaneous Closure of Patent Foramen Ovale and Atrial Septal Defects in Australia

Abhisheik Prashar,Mark Sader,Richard Zhang,Kurt Mitchell,Sanjana Shah

doi:10.3390/hearts2040041

Abhisheik Prashar, Mark Sader + Show 3 more

Open Access

https://doi.org/10.3390/hearts2040041

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Journal: Hearts	Publication Date: Nov 9, 2021
Citations: 2	License type: CC BY 4.0

Affiliation: St George Hospital, UNSW Sydney

Abstract

Background: Percutaneous closure of patent foramen ovale (PFO) and atrial septal defects (ASD) is being more commonly performed due to changes in international guidelines supporting its use. This study was performed to determine the clinical outcomes, safety and cost implications of same-day discharge (SDD) following such procedures and place this in an Australian context. Methods: This was a retrospective, observational study of patients undergoing elective percutaneous PFO or ASD closure at St. George Hospital, Australia between January 2011 and January 2020. Primary outcomes included 30-day major adverse cardiovascular endpoints (MACE) and readmission to hospital within 30 days. Results: Twenty-four patients were included in the primary analysis. Ten (41.7%) patients underwent elective ASD closure while 14 (58.3%) underwent PFO closure. Among the 24 patients who underwent elective percutaneous closure of structural heart disease, 23 patients (95.8%) were managed with SDD. There were no MACE outcomes at 30 days. No patients were re-admitted to hospital at 30 days following these procedures. When compared to overnight admission to hospital post-elective percutaneous structural heart condition closure, SDD yielded a cost saving of AUD 5999 per case. Conclusion: SDD following elective percutaneous closure of ASD and PFO was demonstrated to be a safe and effective strategy for managing patients. With more widespread use, it can lead to significant cost savings for hospitals without compromising patient care.

Highlights

Patent foramen ovale (PFO) and atrial septal defects (ASD) remain two of the most common congenital cardiac anomalies
These procedures have historically been performed under trans-oesophageal echocardiography (TOE), guidance necessitating the use of general anaesthesia with prolonged procedural time [6,7]
Consecutive patients who met the criteria for percutaneous patent foramen ovale (PFO)/ASD closure from September 2011 through to December 2020 were recruited as part of a registry

Summary

Introduction

Patent foramen ovale (PFO) and atrial septal defects (ASD) remain two of the most common congenital cardiac anomalies. Percutaneous closure of secundum ASD is indicated in the presence of hemodynamically significant shunts that cause platypnoea-orthodeoxia syndrome or right ventricular volume overload without pulmonary arterial hypertension or left ventricular disease, or if there is clinical evidence of a paradoxical embolism likely arising from the ASD [4,5]. These procedures have historically been performed under trans-oesophageal echocardiography (TOE), guidance necessitating the use of general anaesthesia with prolonged procedural time [6,7]. This study was performed to determine the clinical outcomes, safety and cost implications of same-day discharge (SDD) following such procedures and place this in an Australian context

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Results

Discussion

Conclusion