Feasibility Of Same-day Discharge Research Articles

Same-day discharge for laparoscopic Heller myotomy.

Laparoscopic Heller myotomy is an effective treatment for achalasia. There are little data on the safety and feasibility of same-day discharge after laparoscopic Heller myotomy. This study aimed to describe the experience with same-day discharge after laparoscopic Heller myotomy at one hospital. A retrospective cohort study including all patients who underwent laparoscopic Heller myotomy between 2007 and 2016 at University Health Network (UHN), Toronto, Canada. There was no consent required as the study was retrospective study. This study was approved by the UHN IRB. Planned same-day discharge patients were compared to planned inpatient with respect to post-op complications, length of stay, and number of emergency visits. A total of 209 patients were identified. Same-day discharge was planned in 67 (33.5%) cases compared to 133 (66.5%) cases that were planned for inpatient. The study population was 49% male. On average, inpatients had 2.3 pre-operative comorbidities and same-day discharge patients had 1.6 pre-operative comorbidities. The average length of stay for the inpatient group was 3.5 days. Among the same-day surgery group, 15 had an unplanned admission following surgery (22%). Of those who were admitted, the average length of stay was 1.27 days. Only 1 same-day discharge was readmitted after hospital discharge, while 4 in inpatient group were readmitted.Thepost-operativecomplicationratewas (15%)20 of inpatientcompared to four (6.0%) of same-daydischarge. Number of emergency visits for inpatient groupwere 7 (5.3%) compared to 3 (4.5%) for same-day dischargegroup.There was one mortality case ininpatient group due to post-op complication. Same-day surgery is feasible for laparoscopic Hellermyotomy, with a similarcomplication and readmission rate as inpatient surgery.

Safety and Feasibility of Day Case PCI in a Cardiac Catheter Laboratory in a Queensland Tertiary Hospital

Traditionally in Queensland, post percutaneous intervention (PCI) care involves admission to a monitored environment. The purpose of this audit was to assess the safety and feasibility of same-day discharge in appropriately selected patients undergoing PCI.

Economic Impact And SafetY of Same-Day Discharge Following Percutaneous Coronary Intervention: A Tertiary-Care Centre Experience From Northern India (EASY-SDD)

BackgroundThe literature about the safety and feasibility of same-day discharge (SDD) following complex percutaneous coronary intervention (PCI) and in acute coronary syndrome (ACS) is scarce. The economic impact of SDD has not been evaluated in this geographical region. We in the present study evaluated the safety, feasibility, and economic impact of SDD following PCI at a tertiary care centre of north India. MethodsIt was a single-centre, non-randomized, prospective study, in which all consecutive PCI patients during the study period of 15 months were evaluated for SDD using a “patient-centred” approach. The patients who were discharged on the next calendar day were included in the next day discharge (NDD) group. The baseline demographic data including coronary risk factors, clinical presentation, and management details were noted for all patients. All patients were followed up for 6 weeks. The Indian health system is only partially insured, hence most of the expendable costs are borne by patients. In the present study, we computed the total societal expenditure of each PCI which includes both the health system costs and the expenditure borne by the patients. A standardized tool and bottoms up costing method were used for recording out-of-pocket expenditure (OOPE) by the patients and health care expenditure respectively. ResultsOut of a total of 675 PCI patients, 617 patients were enrolled in the study, and 132/617 (21.39%) patients were discharged the same day. Sixty-five % of patients (86/132) in the SDD cohort and 70% of patients (337/485) in the NDD cohort presented with ACS. Baseline characteristics in the two cohorts were identical. A higher syntax score, greater number of stents, and longer stented segment predicted the NDD. The mean length of stay after PCI in patients with SDD and NDD was 8.71 ± 2.48 and 21.76 ± 2.42 h, respectively. In the SDD group, there were no readmissions or adverse events after discharge till 6 weeks of follow-up. The total mean cost of PCI (health care system and OOPE) for SDD and NDD was Indian Rupees (INR) 129,322.14 [United States dollar (US$) 1810.51] and INR 165500.71 [US$ 2317.01] respectively. An amount of INR 36178.57 (health system cost: INR 10242.76 and OOPE: INR 25935.71 was saved for each SDD. Besides 100 cardiac unit bed days including 85 intensive cardiac care bed days were saved with 21% SDD in the present cohort. ConclusionPost PCI SDD is safe and feasible in selected ACS/chronic stable angina patients using the “patient-centred” approach. Besides, decreasing OOPE for the patients, SDD also helps in the efficient use of scarce health system resources.

Same-day discharge vs hospital admission after cardiac device implantations: a systematic review and meta-analysis

Abstract Background Due to the increasing need for cardiac device implantations, the cost of healthcare has been rising. This includes the cost of hospital stay after the procedure. Thus, we conducted this systematic review and meta-analysis to assess the safety and feasibility of same-day discharge (SDD) after cardiac device implantations. Methods We searched MEDLINE, and Embase databases from inception to March 2021 to identify studies that compared clinical outcomes between SDD group and hospital overnight stay (HO) group after cardiac device implantations. Outcomes included complications after the procedure, mortality, and rehospitalization. Data from each study were combined using the random-effects model to calculate pooled odds ratio (OR) with 95% confidence interval (CI). Results Six studies (1 randomized control trial, 1 prospective cohort study and 4 retrospective cohort studies) with a total of 59,312 patients were included. SDD was not associated with more procedure-related complications. The pooled ORs for wound problems, pneumothorax, hematoma, and lead dislodgement/repositioning were 0.86 (95% CI: 0.2–3.68, p=0.834), 1.36 (95% CI: 0.26–7.12, p=0.718), 0.35 (95% CI: 0.01–9.85, p=0.534), and 1.71 (95% CI: 0.64–4.54, p=0.281) respectively. Readmission rate (pooled OR= 1.38, 95% CI: 0.51–3.69, p=0.524) and mortality rate (pooled OR= 0.86, 95% CI: 0.62–1.2, p=0.383) were similar between both groups. As shown in figure 1. Conclusions Our meta-analysis suggested that same-day discharge after cardiac device implantations is a safe and feasible alternative to a hospital overnight stay strategy. Funding Acknowledgement Type of funding sources: None.

Same-day discharge after implantation of cardiac implantable electronic devices: A systematic review and meta-analysis.

Due to an increasing need for cardiac implantable electronic device (CIED) placement, the cost of healthcare has been rising including the cost of hospital stay after the procedure. We conducted this systematic review and meta-analysis to assess the safety and feasibility of same-day discharge (SDD) after cardiac device implantations. We searched MEDLINE, and Embase databases from inception to March 2021 to identify studies that compared clinical outcomes between SDD group and hospital overnight stay (HO) group after cardiac device implantations. Outcomes included complications after the procedure, mortality, and re-hospitalization. Data from each study were combined using the random-effects model to calculate pooled odds ratio (OR) with 95% confidence interval (CI). Eight studies (one randomized control trial, three prospective cohort and four retrospective cohort studies) with a total of 61,602 patients (4153 in SDD group and 57,449 in HO group) were included. SDD was not associated with more procedure-related complications. The rates of wound problems (0.94%vs 1.84%, pooled OR=0.86, 95%CI: 0.2-3.68, p=.834), pneumothorax (1.15%vs 0.73%, pooled OR=1.36, 95%CI: 0.26-7.12, p=.718), hematoma (0.59%vs 2.32%, pooled OR=0.35, 95%CI:0.01-9.85, p=.534), lead/device dislodgement (4%vs 2.48%, pooled OR=1.71, 95%CI: 0.64-4.54, p=.281), readmission rate (17.6%vs 17.5%, pooled OR=0.95, 95%CI: 0.74-1.21, p=.667), and mortality rate (1.66%vs 1.44%, pooled OR=0.77, 95%CI: 0.58-1.01, p=.059) were similar between in SDD and HO groups respectively. Our meta-analysis suggested that SDD after cardiac device implantations might be a safe and feasible alternative to HO without differences in procedure-related complications, readmission rates, or mortality rates.

S1026 Safety and Feasibility of Same Day Discharge for Endoscopic Bariatric Therapy

S1026 Safety and Feasibility of Same Day Discharge for Endoscopic Bariatric Therapy

PD28-09 SAFETY AND FEASIBILITY OF SAME-DAY DISCHARGE FOLLOWING SINGLE-PORT ROBOTIC-ASSISTED LAPAROSCOPIC PROSTATECTOMY

You have accessJournal of UrologyHealth Services Research: Quality Improvement & Patient Safety I (PD28)1 Sep 2021PD28-09 SAFETY AND FEASIBILITY OF SAME-DAY DISCHARGE FOLLOWING SINGLE-PORT ROBOTIC-ASSISTED LAPAROSCOPIC PROSTATECTOMY Carrie Ronstrom, Joel Vetter, Julia Sheets, Vicky Peck, Sherb Figenshau, and Eric Kim Carrie RonstromCarrie Ronstrom More articles by this author , Joel VetterJoel Vetter More articles by this author , Julia SheetsJulia Sheets More articles by this author , Vicky PeckVicky Peck More articles by this author , Sherb FigenshauSherb Figenshau More articles by this author , and Eric KimEric Kim More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002029.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Prior studies have demonstrated the safety of same-day discharge (SDD) following robotic prostatectomy using the multiport robot. At our institution, the da Vinci Single-Port (SP) robot was first used for a robotic prostatectomy in November 2019 and has since been used routinely for prostatectomies. Given the coronavirus pandemic and increased hospital capacity, SDD has become desired. This study was developed to determine safety and feasibility of SDD following SP robotic prostatectomy. METHODS: Patient data was collected from January 2020 to December 2020. SDD was offered to patients starting March 2020. Criteria for SDD included: patients had to obtain surgeon approval, have a caregiver stay overnight the first night after surgery, had to ambulate, tolerate oral intake, and have pain controlled on oral medications. Following discharge, patients who underwent SP robotic prostatectomy received a telephone survey regarding outcomes and opinions regarding SDD. Patient medical records were reviewed to evaluate readmissions and complications. RESULTS: Fifty-one patients were included in the study, 15 of whom underwent SDD. In total there were 8 readmissions and emergency department (ED) visits, four occurred in the SDD group and four in the standard discharge group. Table 1 includes details on visit reasons and timing post-operatively. There was no statistical difference in rate of ED visits, or readmissions within 7-days, 30-days or 90-days between the two groups (p value 0.34, 1.00, 1.00, 0.14 respectively). The only readmission/ED visit that may have been avoided with standard discharge was for kinked catheter on post-operative day (POD) 0. On follow up survey, all patients who discharged same day, except the patient with POD 0 complication, endorsed that SDD remained the right choice for them in retrospect. CONCLUSIONS: SDD following SP robotic prostatectomy appears to be feasible and safe without significant increase in readmissions or ED visits. When offered to patients who met criteria, greater than 90% who underwent SDD felt it remained the correct decision for them in hindsight. Source of Funding: N/A © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e523-e524 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Carrie Ronstrom More articles by this author Joel Vetter More articles by this author Julia Sheets More articles by this author Vicky Peck More articles by this author Sherb Figenshau More articles by this author Eric Kim More articles by this author Expand All Advertisement Loading ...

Enhanced Recovery and Same-Day Discharge After Minimally Invasive Sacrocolpopexy.

The objective of this study was to evaluate whether an enhanced recovery after surgery (ERAS) protocol was associated with a higher rate of same-day discharge after robot-assisted or laparoscopic sacrocolpopexy and to describe the safety and feasibility of same-day discharge after these procedures. A historical control, retrospective cohort study of women undergoing minimally invasive sacrocolpopexy comparing rates of same-day discharge before and after implementation of an ERAS protocol was conducted. Secondary outcomes were obtained by comparing women discharged the same day with those discharged postoperative day ≥1, including postoperative complications and unplanned postoperative patient encounters within 30 days of surgery. Logistic regression was performed to control for potential confounders. Of the 166 women identified (83 before ERAS implementation; 83 after ERAS implementation), 43 underwent same-day discharge versus 123 admitted overnight. The rate of same-day discharge increased 28 percentage points after ERAS implementation (12% vs 40%, P < 0.01). Compared with women admitted overnight, same-day discharge women had shorter procedures (154 vs 173 minutes, P = 0.01), spent longer time in the postanesthesia care unit (130 vs 106 minutes, P = 0.01), and were more likely to be discharged with a Foley catheter (58% vs 28%, P < 0.01). After multivariable logistic regression analysis, ERAS was associated with increased odds of same-day discharge (odds ratio, 4.91; 95% confidence interval, 2.17-11.09). There were no differences in unplanned postoperative patient contacts or postoperative complications within 30 days between same-day discharge and overnight admission groups. Implementation of an ERAS protocol for minimally invasive sacrocolpopexy was associated with a 3-fold increase in same-day discharge.

Same-day discharge vs. observation after laparoscopic pediatric appendectomy: a prospective cohort study.

Through 2015, the practice at our university based free-standing children's hospital was to admit uncomplicated appendicitis patients for overnight observation post-operatively. Given the increasing body of evidence suggesting the safety and feasibility of same-day discharge after appendectomy for uncomplicated appendicitis, we elected to perform a prospective study evaluating the complication rates of same-day discharge compared to overnight observation at our institution, given our large volume of appendicitis. Pediatric patients who underwent laparoscopic appendectomies for uncomplicated appendicitis in 2016 were analyzed. Data regarding demographics, admission, and discharge times and outcomes of complications, as well as readmissions, return to the emergency department, and nonscheduled clinic visits were collected and analyzing using chi-square and multivariate regression. Cost of stay data was obtained and analyzed using Mann-Whitney U test to compare non-parametric variables. Eight hundred and forty-nine laparoscopic appendectomies were performed for uncomplicated appendicitis during the study period, of which 382 resulted in same-day discharge and 467 in an admission for observation. Univariate analysis revealed no statistical difference between readmission rates for same day vs. observation (2 vs. 6 patients; P=0.21) or in emergency department visits within 30 days (22 vs. 27 patients; P=0.98). There was no difference in the number of surgical site infections or extra clinic visits. There was a significantly lower median cost of stay for patients discharged home the same day at 29,150 dollars (25,644, 32,276, IQR) compared to a median of 34,827 dollars (31,154, 39,457, IQR) (P<0.0001). Same-day discharge for laparoscopic uncomplicated appendectomy should be the new standard of care. This study found no differences in outcomes between the timing of discharge, with a significantly lower cost of stay for patients discharged home the same day.

Safety and feasibility of same-day discharge in patients receiving pulmonary vein isolation-systematic review and a meta-analysis.

The purpose of this systematic review and meta-analysis was to evaluate the feasibility and safety of a same-day discharge protocol following pulmonary vein isolation (PVI). PubMed and Embase were systematically investigated from the inception to 20 July 2020. Studies on safety and feasibility of PVI for atrial fibrillation (AF) were included. Study-specific estimates were combined using one-group meta-analysis with a random-effects model. Seven observational studies investigating the safety and feasibility of same-day discharge protocols were identified. Of a total of 3656 patients who have undergone PVI for AF, the overall complication rate was 0.80% (95% confidence interval [CI], 0.20-1.40%). The readmission within 30-day following same-day discharge protocol occurred at a pooled rate of 3.6% (95% CI, 0.0-8.4%). Frequent complications following the procedure were complications related to vascular access (0.38%; 95% CI, 0.18-0.58%), and phrenic nerve injury (0.19%; 95% CI, 0.05-0.33%). The reported complications in SDD group were mainly based on results among patients without perioperative complications. The introduction of same-day discharge strategies might be safe and feasible in selected patients given the reported complication and re-admission rates in the current practice. Further prospective studies are needed to confirm these findings.

Safety and Feasibility of Same-Day Discharge After Left Atrial Appendage Closure With the WATCHMAN Device.

Background:As the use of left atrial appendage closure (LAAC) becomes more widespread, improvements in resource utilization and cost-effectiveness are necessary. Currently, there are limited data on same-day discharge (SDD) after LAAC. We aimed to evaluate the safety and feasibility of SDD versus non-SDD in patients with nonvalvular atrial fibrillation who underwent LAAC.Methods:We retrospectively studied 211 patients who underwent the WATCHMAN procedure in a tertiary hospital (June 2016 to June 2019). The primary safety outcome was the composite of stroke, systemic embolism, major bleeding requiring transfusion, vascular complications requiring endovascular intervention, or death through 7 days (periprocedural) and 45 days post-procedure. The secondary outcomes were the individual components of the primary outcome and all-cause readmission. We compared the clinical outcomes of patients who had SDD and non-SDD post-procedure.Results:Patients with procedure-related complications on the day of LAAC and patients who were admitted for acute clinical events before LAAC were excluded. One hundred ninety patients were included in the final analysis. Seventy-two of 190 (38%) patients had SDD, and 118 of 190 (62%) had non-SDD. There were no statistically significant differences in the primary safety outcome through 7 days (1.4% versus 5.9%; P=0.26) and 45 days post-procedure (2.8% versus 9.3%; P=0.14) between the two groups. The secondary outcomes were similar in both groups. No patients had device-related thrombus on transesophageal echocardiography at 45 days. Only 1 patient from the non-SDD group had clinically significant peri-device flow (>5 mm) at 45 days.Conclusions:In a selected cohort of patients who underwent successful elective LAAC with WATCHMAN without same-day procedure-related complications, the primary safety outcome and secondary outcomes through 7 and 45 days post-procedure were similar in the SDD and non-SDD groups. Our findings are hypothesis generating and warrant further investigation in prospective trials.

Safety of same‐day discharge after uncomplicated, minimalist transcatheter aortic valve replacement in the COVID‐19 era

We sought to evaluate the safety, efficacy and feasibility of same-day discharge after uncomplicated, minimalist TAVR. At the start of the COVID-19 pandemic, we created a same-day discharge (SDD) pathway after conscious sedation, transfemoral (minimalist) TAVR to help minimize risk of viral transmission and conserve hospital resources. Studies support that next-day discharge (NDD) for carefully selected patients following minimalist TAVR is safe and feasible. There is a paucity of data regarding the safety of SDD after TAVR. In-hospital and 30 day outcomes of consecutive patients meeting pre-specified criteria for SDD after minimalist TAVR at our institution between March and July of 2020 were reviewed. Outcomes were compared to a NDD cohort from July 2018 through July 2020 that would have met SDD criteria. Primary endpoints were mortality, delayed pacemaker placement, stroke and cardiovascular readmission at 30 days. Twenty nine patients were discharged via the SDD pathway after TAVR. 128 prior NDD patients were identified who met all criteria for SDD. The STS scores were similar between the two groups (SDD 2.6% ±1.5 vs. NDD 2.3% ± 1.2). There were no deaths at 30 days in either group. There was no significant difference in delayed pacemaker placement (SDD 0% vs. NDD 0.8%, p > .99) or cardiovascular readmission (SDD 0% vs. NDD 5.5%, p = .35) at 30 days. Same day discharge following uncomplicated, minimalist TAVR in selected patients appears to be safe, achieving similar 30 day outcomes as a cohort of next day discharge patients.

Adoption of same day discharge following elective left main stem percutaneous coronary intervention

BackgroundThis study sought to investigate the safety and feasibility of same day discharge (SDD) practice and compare clinical outcomes to patients admitted for overnight stay (ON) undergoing elective left main stem (LMS) percutaneous coronary intervention (PCI). ON observation is still widely practiced in highly complex PCI as the standard of care, with no previous data comparing clinical outcomes in patients undergoing LMS PCI. MethodsWe analysed 6452 patients undergoing elective LMS PCI between 2007 and 2014 in England and Wales. Multiple logistic regressions and the BCIS risk model were used to study association between SDD and 30 day mortality. ResultsSDD rates almost doubled from 19.9% in 2007 to 39.8% in 2014 for all LMS procedures and increased from 20.7% to 41.4% for unprotected LMS cases during the same study period. There was a significant increase in procedural complexity with higher use of rotational atherectomy, longer stents and multivessel PCI. SDD was not associated with increased 30 day mortality (OR 0.70 95%CI 0.30–1.65) in the overall LMS PCI cohort and the results were similar in unprotected LMS (OR 0.48 95%CI 0.17–1.41) and those requiring ON stay (OR 0.58 95%CI 0.25–1.34). ConclusionsWe did not find evidence that SDD is not safe or feasible in highly complex LMS PCI procedures despite increasing procedural complexity with no significant increase in 30 day mortality rates.

Safety and feasibility of same-day discharge after esophageal endoscopic submucosal dissection

Endoscopic submucosal dissection (ESD) is used for treating early luminal GI cancers. ESD is the standard of care in Asia, where it results in multiday admissions for observation. The goal of our study was to evaluate the safety and feasibility of same-day discharge (SDD) after ESD. This is a retrospective cohort study of adults who underwent similar esophageal ESD with a Clutch Cutter device (DP2618DT; Fujifilm) at the Mayo Clinic (Rochester, Minn, USA) from 2017 to 2019 with a single endoscopist. The primary end point was postprocedural adverse events within 7 days of ESD. Of 96 patients (75% male, mean age, 70 ± 10.3 years) undergoing a total of 140 ESDs, 85 were SDD versus 55 admissions. Of the 55 admits, 53 were discharged within 24 hours, whereas 2 were admitted for 2 to 3 days for reasons unrelated to the ESD procedure. Admissions were more likely to have a history of antiplatelet/anticoagulant use (56.4% vs 34.1%; P= .01) and higher mean American Society of Anesthesiologists (ASA) score (3.2 vs 2.9; P= .007). Admissions had larger resections (28.6 vs 20.1mm; P< .0001) with longer procedural durations (103.4 vs 62 minutes; P< .0001). Among SDDs, no intraprocedural or postprocedural adverse events were seen. Among admissions, 1 (1.8% vs 0%; P= .39) experienced intraprocedural bleeding requiring endoscopic intervention, 1 required transfusion before discharge within 24 hours of ESD (1.8% vs 0%; P= .39), and 1 required rehospitalization and endoscopic intervention within 7 days to address an active bleed along the resection margin (1.8% vs 0%; P= .39). SDD after esophageal ESD is safe and feasible. An experienced endoscopist can determine if SDD can be considered in patients with ASA physical classification status≤2 who undergo resections off antiplatelet/anticoagulant therapy and do not experience intraprocedural adverse events.

Same-day discharge is safe and feasible following POEM surgery for esophageal motility disorders.

Per-oral endoscopic myotomy (POEM) is an effective treatment for achalasia and other esophageal dysmotility disorders. Current practices surrounding post-operative care involve admission and routine esophagogram prior to discharge. This study aims to establish the safety and feasibility of same-day discharge following POEM. Retrospective analysis of prospectively collected data for patients who underwent POEM between November 2013 and June 2019 at a single institution in Ontario, Canada. Patients were discharged home on the same day with controlled pain, when tolerating clear fluids. Patients were admitted if clinically indicated. Esophagography was initially a systematic practice prior to discharge, but later only performed when clinically indicated. Emergency department visits and hospital admissions within 90days were assessed. In total, 90 patients underwent a successful POEM procedure. A total of 72 patients (79.1%) were discharged on the same day, 14 patients (15.4%) were discharged home the following day, and 5 patients (5.5%) experienced longer admissions to hospital. One POEM was unsuccessful. 22 (24.2%) patients had adverse events, leading to 8 (8.8%) unplanned admissions, with one patient requiring prolonged admission for esophageal leak, identified clinically. Fifty-three patients underwent routine esophagography while part of our protocol, with no identified leak, which prompted our change in practice to only perform esophagography when clinically indicated. In the 90-day post-procedure, ten patients visited the emergency department, of which seven were re-admitted, five for POEM-related issues. Our mean Eckhardt score at 2weeks was 2.1 from 7.2 preoperatively. This study establishes that same-day discharge is both safe and feasible following POEM and suggests that esophagography should be performed only when clinically indicated. This represents a shift from the routine practice of admission and imaging for patients undergoing POEM, encouraging the transition to outpatient POEM procedures.

Mo1289 SAFETY AND FEASIBILITY OF SAME DAY DISCHARGE FOLLOWING ESOPHAGEAL ENDOSCOPIC SUBMUCOSAL DISSECTION

Endoscopic submucosal dissection (ESD) is an endoscopic resection technique used for the treatment of early luminal gastrointestinal cancer. ESD has become standard of care in East Asia, where it results in a multi-day hospital admission for observation. Similarly, in the US, standard of care usually involves at least an overnight hospital stay. There is, however, limited data regarding practice in Western hospitals. To evaluate the safety and feasibility of same day discharge (SDD) following esophageal ESD. This is a retrospective cohort study of adults who underwent esophageal ESD with a Clutch Cutter device (DP2618DT; Fujifilm Corporation, Tokyo, Japan) at Mayo Clinic (Rochester, MN) from 2017-2019. The primary end point was post-procedural complications within 7 d of ESD, including need for physician phone call, Emergency Department visit, rehospitalization, and medical or endoscopic intervention. Of 96 patients (75% male, mean age 70±10.3 y) undergoing a total of 140 ESDs, 85 (60.7%) were SDDs vs 55 (39.3%) who were admitted. Of the 55 admits, 53 (96.4%) were discharged within 24 h, while 2 (3.6%) were admitted 2-3 d due to hypertensive urgency and TIA unrelated to ESD. SDD patients vs admits were similar in mean age (69.2 vs 71.4 y; p0.22) and sex (75.3% vs 71.4%; p0.84). However, admits were more likely to have a history of antiplatelet/anticoagulant (AP/AC) use (56.4% vs 34.1%; p0.01) and higher mean ASA physical status score (3.2 vs 2.9; p0.007). Admits had larger resections (28.6 vs 20.1 mm; p<0.0001) with longer durations (103.4 vs 62 min; p<0.0001). No difference in fibrosis was noted (12.7% vs 17.6%; p0.48). Among SDDs, no intraprocedural or post-procedural complications were seen. Among admits, 1 (1.8% vs 0%; p0.39) experienced intraprocedural bleeding requiring endoscopic intervention, 1 required transfusion prior to discharge within 24 h of ESD (1.8% vs 0%; p0.39), and 1 required rehospitalization and endoscopic intervention within 7 d to address an active bleed along the resection margin (1.8% vs 0%; p0.39). Overall, associated pathology was as follows: 5% had normal findings; 13.6% non-dysplastic Barrett’s esophagus (BE); 2.9% BE with indefinite dysplasia; 13.6% BE with low grade dysplasia; 20.7% BE with high grade dysplasia; 27.9% esophageal adenocarcinoma; 6.4% squamous cell carcinoma; and 10.0% had other findings, such as squamous dysplasia. Patients were on AP/AC therapy leading up to 42.9% of the procedures, including 5.7% on high dose aspirin, 2.9% clopidogrel, 6.4% warfarin, and 8.6% direct oral anticoagulants. SDD following esophageal ESD is safe and feasible. Additional prospective data will help establish more uniform criteria for low risk patients. Based on our experience, SDD can be considered in patients who are fit with ASA £2 and undergo smaller resections off AP/AC therapy.

Safety and Feasibility of Same-Day Discharge After Left Atrial Appendage Closure

Subacute or late complications > 24 hours after left atrial appendage closure (LAAC) are infrequent. We therefore created a clinical pathway to enable safe same-day discharge (SDD) after LAAC. Patients were assessed for overall physical conditioning, lack of significant frailty and comorbidities limiting physical abilities, good home support, and patient preference. Of 78 LAACs performed, 24 patients (30.8%) were discharged the same day: 21 were transesophageal echocardiography guided and 3 intracardiac echocardiography guided. SDD clinical pathway patients were discharged 395.4 ± 56.6 minutes after leaving the procedural room. There were no clinical complications at 1 month or in long-term follow-up. SDD is safe and feasible after LAAC, following a dedicated clinical pathway and surveillance in carefully selected patients.

Safety and feasibility of same-day discharge after elective percutaneous balloon mitral valvotomy: a prospective, single-center registry in India

Background Percutaneous mitral balloon valvotomy (PBMV) is an alternative to surgery for patients with severe mitral valve (MV) stenosis. However, the safety and feasibility of same-day discharge (SDD) in patients undergoing elective PBMV for severe MV stenosis is yet to be investigated. This study aimed to assess safety and feasibility of SDD in patients undergoing elective PBMV because of severe MV stenosis in a tertiary-care hospital in India. Methods From January 2018 to November 2018, patients with a diagnosis of severe MV stenosis were treated with PBMV at our institution. Among these patients, those suitable for SDD were prospectively included in this registry. Vascular access was achieved in forearm arteries and femoral veins. Clinical, echocardiographic and hemodynamic features were collected before and after PBMV. The primary outcome was 30-day mortality. The secondary outcome was incidence of in-hospital complications. Other outcomes of interest were arterial spasm and forearm haematoma. Results A total of 98 patients scheduled for SDD after elective PBMV were included in the registry. Mean MV area increased from 0.8 ± 0.1 to 1.6 ± 0.2 cm2 (p < .001). Severe MV regurgitation after PBMV occurred in 3 patients, and 1 patient developed pericardial tamponade. Severe arterial spasm occurred in 2 patients. None of the included patients developed a clinically relevant haematoma of forearm. A total of 94 (96%) were discharged on the same day. No patient died up to 30-day follow-up. Conclusion PBMV from the venous access site can reduce the hospital stay of patients to less than a day with less local site complications.

1406 Same-Day Discharge Following Vaginal Hysterectomy with Pelvic Floor Reconstruction: A Pilot Study

Study Objective Determine safety and feasibility of same-day discharge in patients undergoing vaginal hysterectomy with pelvic floor reconstruction. Design Prospective cohort pilot study. Setting Single academic medical center. Patients or Participants Women undergoing vaginal hysterectomy with pelvic floor reconstruction were considered for inclusion in the study. Interventions Same-day discharge or overnight hospitalization following surgery. Measurements and Main Results A total cohort of 55 women undergoing vaginal hysterectomy and pelvic floor reconstruction for pelvic organ prolapse and/or urinary incontinence was identified. The control group consisted of 19 women that were planned for overnight hospitalization. The intervention group had 36 women that were planned for same-day discharge. In the intervention group, 63.9% of patients (n=23) were successfully discharged home and 36.1% (n=13) required an unplanned overnight admission. Reasons for unplanned admission included persistent anesthetic effects (dizziness/nausea/drowsiness) (n=9; 69%), uncontrolled pain (n=1, 7.7%), fever (n=1, 7.7%), anemia (n=2, 15.4%), with return to operating room for hematoma evacuation (n=1; 7.7%). Voiding trial was passed on first attempt in 30 patients (54.5%). The percentage of successful voiding trials on the first attempt was 30.8% for patients requiring unplanned admission and 78.9% for patients with planned overnight hospitalization (p = 0.011). There were no significant differences in the number of emergency department visits (p=0.677) or unplanned office visits (p=0.193) between the control and intervention groups. Conclusion Same-day discharge after vaginal hysterectomy with pelvic floor reconstruction appears to be safe and feasible. Patients who were discharged the same-day did not require a higher volume of emergency department or office evaluations.

TCT-767 Safety and Feasibility of Same Day Discharge Using the Vancouver PFO/ASD Clinical Pathway

Although rates of atrial septal defect (ASD) closure are stable, dramatic increases in the rates of patent foramen ovale (PFO) closure have placed greater demands on existing catheterization laboratory resources. The Vancouver PFO/ASD Clinical Pathway (Figure 1) was designed to facilitate same-day