Same-day Discharge Research Articles

BN SO57 - Transversus Abdominis Plane (TAP) Block in Laparoscopic and Robot-Assisted Cholecystectomy: Is it worth the effort?

Abstract Background Minimal access cholecystectomy is a common procedure undertaken worldwide. These are usually performed on an ambulatory basis and given the short timeline, strategies to optimize pain control and reduce nausea or vomiting are key factors to facilitate early hospital discharge. There has been studies showing that both TAP block and wound infiltration deliver superior pain relief after laparoscopic cholecystectomy, but TAP blocks are not used routinely after cholecystectomy in the U.K. This study aims to assess the efficacy of post-operative subcostal TAP block in laparoscopic and robot-assisted cholecystectomy in reducing post-operative opioid requirements and facilitating same day discharge. Method A retrospective cohort analysis was performed at a single centre (January 2022 – July 2023). Patients undergoing laparoscopic or robot assisted cholecystectomy under a single surgeon who performs cholecystectomy with additional use of postoperative TAP block were included. The primary outcome of post-operative opioid requirements was assessed. Secondary outcomes included length of post-operative stay and individual morphine/fentanyl requirements. Results Among 87 patients, 22(25.3%) underwent TAP block and 65(74.7%) had local anaesthetic infiltration of the port sites. Of the two cohorts, there were no significant differences in the age, M:F ratio or ASA grade. There were more obese patients (BMI > 30kg/m2) in the TAP block cohort (63.6% vs 47.7%; p= 0.012). Of the patients in the TAP block, 88.2% were discharged the same day. 95.5% of these patients had no post-operative morphine or fentanyl requirements.The difference in outcomes were not statistically significant. There were no post-procedural complications from use of the TAP block in any patient. Conclusion These results demonstrate that use of TAP block can provide a safe alternative approach for post-operative analgesia, with low post-operative opioid requirements and facilitation of same-day discharge.

Abstract 4138782: A Meta-Analysis Comparing Same-Day Discharge to Later-Day Discharge in Transcatheter Aortic Valve Replacement

Background: One of the benefits of transcatheter aortic valve replacement (TAVR) over surgical aortic valve replacement (SAVR) is the possibility of same-day discharge, allowing for early mobilization and reduced total hospital stay. However, there is limited evidence comparing same-day discharge to later-day post-TAVR discharge. This meta-analysis aimed to compare the outcomes of same-day and later-day discharge post-TAVR in patients with aortic stenosis. Methods: A systematic bibliographic search was conducted using electronic databases, including PubMed, Embase, and the Cochrane Library, from inception to May 23, 2024. We pooled the risk ratios (RR) with 95% confidence intervals (CI) using the inverse-variance random-effects model. Statistical significance was set at p <0.05. Results: Six studies were included with 71,550 patients undergoing TAVR (2215: same-day discharge; 69335: later-day discharge). The mean age for the same-day and later-day discharge groups was 77.3 ± 8.3 and 78.3 ± 8.5, respectively. Same-day discharge for patients post-TAVR was associated with a higher risk of 30-day stroke [RR: 1.93; 95% CI: 1.14, 3.27] and 30-day major vascular complications [RR: 1.82; 95% CI: 1.02, 3.24] as compared to later-day discharge post-TAVR. However, no significant differences in the risks of 30-day mortality [RR: 0.30; 95% CI: 0.06, 1.57], 30-day readmission [RR: 0.93; 95% CI: 0.66, 1.32], 30-day major bleeding [RR: 0.86; 95% CI: 0.52, 1.42], 30-day new permanent pacemaker [RR: 1.00; 95% CI: 0.81, 1.22], 30-day acute kidney injury [RR: 1.04; 95% CI: 0.73, 1.49], and 30-day valve reintervention [RR: 5.77; 95% CI: 0.60, 55.39] were noted between the two groups. Conclusion: This meta-analysis concluded that same-day discharge post-TAVR is associated with a higher risk of 30-day stroke and 30-day major vascular complications than later-day discharge after TAVR. Same-day discharge was comparable to later-day discharge post-TAVR in terms of 30-day mortality, 30-day readmission, 30-day major bleeding, 30-day new permanent pacemaker, 30-day acute kidney injury, and 30-day valve reintervention. This study underscores the possibility of same-day discharge after uncomplicated TAVR in select patients. Further randomized studies are required to evaluate the safety and feasibility of the same-day discharge protocols.

INNV-17. SAME-DAY DISCHARGE AFTER LASER INTERSTITIAL THERMAL THERAPY: A PROSPECTIVE COHORT PILOT STUDY WITH A MATCHED CONTROL GROUP

Abstract BACKGROUND Laser interstitial thermal therapy (LITT) has emerged as a minimally invasive treatment modality for intracranial pathologies, offering precision and control over tissue damage. With implementation of enhanced recovery after surgery (ERAS) protocols within neurosurgery, identifying patients amenable for same-day discharge (SDD) is an important step towards streamlining perioperative care following LITT, and correspondingly, we aim to summarize our initial experience. METHODS We conducted a prospective study at the University of Miami Hospital of 7 patients who underwent LITT for intracranial pathologies and were discharged on the same day of ablation (post-ablation day 0, PAD0). We then performed a retrospective case-control study against a historic matched PAD1 cohort comparing categorical and continuous variables for statistical significance. RESULTS The mean age of the PAD0 cohort was 55 years with 71% males. Preoperative neurological status and comorbidities did not differ significantly between the PAD0 and PAD1 cohorts for KPS (median [IQR]: 80 [80-90] vs. 90 [80-90], p=0.40), mFI-5 (median [IQR]: 1 [1.5] vs. 0 [1], p=0.54), and mFI-11 (median [IQR]: 1 [1.5] vs. 1 [1], p=0.52). PAD0 outcomes demonstrated no immediate complications, neurosurgical readmissions, or significant neurological deficits within 6 months post-procedure and were non-significantly different than PAD1 patients. No PAD0 patient experienced intracranial hemorrhage or vasogenic edema following LITT that necessitated further intervention. CONCLUSIONS Our study demonstrates the safety and feasibility of same-day discharge following LITT for intracranial pathologies in the appropriately selected patient. Through meticulous patient selection and optimized perioperative protocols, expedited recovery without compromising patient outcomes was achieved. This approach holds potential for substantial cost savings and resource optimization within healthcare systems. Further research and quality improvement initiatives are warranted to refine patient selection criteria and maximize the benefits of same-day discharge in LITT practice.

My patients can go home in the evening after pulmonary vein isolation : Pros and cons

Given the background of optimizing financial and personnel resources while aligning with patient needs, the concept of same-day discharge following pulmonary vein isolation (PVI) appears attractive. However, a non-selective approach to different strategies is inappropriate, as is often the case in medicine. A "one size fits all" approach is therefore not advisable for outpatient PVI. Instead, the primary focus should be on identifying which patients can safely and effectively undergo PVI in an outpatient setting and which patients would benefit from inpatient care. Both procedural and patient-specific criteria should be considered in this context. In addition, structural prerequisites must also be met. Ultimately, the decision as to whether outpatient PVI is feasible should remain with the treating physician and the patient.

Evaluating Software-Based Methods for Replacing Manual Collection of Midnight Totals: A Study from Sri Lanka

The manual collection of midnight totals in hospitals has long been used to calculate key performance indicators such as bed occupancy rates. Despite technological advancements, many hospitals still rely on labour-intensive manual methods prone to inaccuracies at multiple stages. This study introduces and evaluates the Smart Hospital Metrics Calculator, a tool developed to automate the calculation of midnight totals and same-day discharges using patient admission and discharge dates from the electronic Indoor Morbidity and Mortality Return (eIMMR). Both manual and software-based methods exhibited inaccuracies, but errors in software-based calculations were primarily due to issues with entering dates, which can be mitigated by improving workflows and refining the eIMMR system. In contrast, improving manual methods requires addressing challenges across multiple levels. Data from three hospitals were analysed, and while the results do not yet demonstrate these outcomes, it is postulated that with enhanced date entry processes, software-based methods, such as the Smart Hospital Metrics Calculator, could achieve near-zero inaccuracies. These findings suggest that transitioning to this automated approach has the potential to streamline data collection, enable real-time monitoring, and improve hospital data management—without requiring additional workload or significant investment. If successfully implemented, this change could represent a seamless transformation, realizing benefits without disrupting current operations.

Same-day discharge for pediatric Nuss procedure; an analysis of the NSQIP-pediatric database from 2017-2022.

Limited data exists evaluating same-day discharge for pediatric Nuss procedure; most being single-center studies. Our analysis, using the NSQIP-P registry, aimed to assess if same-day discharge for the Nuss procedure influenced post-operative outcomes. The NSQIP-P database (2017-2022) identified patients who underwent the Nuss procedure. Patients discharged same-day postoperatively (SDD) were compared to those discharged 1-7days postoperatively (non-SDD). Of 5486 patients identified, 91 (1.7%) were SDD. From 2018 to 2022, the annual SDD rate increased from 0.8% to 2.7%. There was no significant difference between SDD and non-SDD groups for 30-day readmission (1.1% vs 3.5%, p = 0.376), reoperation (0% vs 1.5%, p = 0.643), or other outcomes. Twenty-six patients required readmission or reoperation within 3-days; only one underwent SDD. The most common readmission was for pain (n = 4) and reoperation for chest-tube placement (n = 10). Asthma (OR 1.66, 95% CI 1.03-2.67, p = 0.038), and increased operative time (per 10min increment: OR 1.060, 95% CI 1.034-1.086, p < 0.001) each increased risk of readmission or reoperation. Same-day discharge for the Nuss procedure, although infrequent, has increased without significant differences in complications in the 91 patients who were discharged same-day in this analysis. Same-day discharge for Nuss procedure is reasonable for non-asthmatic patients with a satisfactory postoperative x-ray and meeting other goal-based discharge criteria, including adequate pain control. Level III.

Same day discharge after hepatectomy: Can it be done safely?

With the advent of minimally invasive techniques and enhanced recovery pathways, outpatient surgery is becoming increasingly common, but has not yet been extensively described in liver surgery. The aim of the present study was to analyze the incidence, characteristics, and outcomes of patients undergoing outpatient hepatectomy in the US. We utilized the National Surgical Quality Improvement Program (NSQIP) database for patients who underwent laparoscopic or robotic, elective hepatectomy from 2014 to 2021. Patients discharged on postoperative day 0 were assigned to the "same-day discharge" group, otherwise the patient was considered "admitted." Postoperative outcomes were compared with propensity-matched analysis. Multivariate analysis was performed to identify predictors of postoperative LOS (length of stay). We identified 7279 patients, of which 361 were in the same-day discharge cohort and 6918 were in the admitted cohort. For admitted patients, median postoperative length of stay was three days (SD = 6). Same-day discharge patients tended to be younger (age 59 vs. 62, p = .034) and more often ASA class ≤2 (49% vs. 29%, p < .001). Comorbidities such as hypertension (40% vs. 45%, p = .048) and diabetes (12% vs. 19%, p = .002) were less common in the same-day discharge cohort. On propensity-matched comparison, there was no significant difference in 30-day mortality (p > .9), 30-day readmission (p = .2), and overall postoperative complication rate (p = .2). Predictors of longer postoperative LOS included longer operative time, inpatient hospital status, preoperative transfusion, dependent functional status, and use of neoadjuvant chemotherapy. Our results indicate that for low-risk patients and uncomplicated cases, same-day discharge after minimally invasive, elective hepatectomy is feasible without compromising patient safety and outcomes.

Correction to: Same-Day Discharge After Elective Percutaneous Coronary Intervention for Chronic Total Occlusion in the UK

Correction to: Same-Day Discharge After Elective Percutaneous Coronary Intervention for Chronic Total Occlusion in the UK

Trends and outcomes in pediatric laparoscopic appendectomy: a NSQIP-P analysis of same-day discharge and readmission rates.

Practice patterns of same-day discharge for pediatric laparoscopic appendectomy for non-perforated appendicitis are not well-analyzed. Our aim is to evaluate current practice patterns and outcomes of same-day discharge for these patients. NSQIP-P retrospective registry identified patients (2017-2021) who underwent laparoscopic appendectomy for non-perforated appendicitis. Annual same-day discharge (SDD) rate was determined. SDD patients were compared to those discharged postoperative days 1-2 (non-SDD). Sub-group analysis was performed on ICD-10 code K35.30. Regression was performed. Overall, 67,214 patients were identified. The SDD rate increased from 33.3% (2017) to 52.5% (2021) with decreased 30-day readmissions between SDD and non-SDD (1.3% vs 2.1%, p < 0.001). Sub-group analysis identified 7,330 patients with SDD rates from 50.7% (2019) to 60.4% (2021) with decreased 30-day readmissions (1.3% vs 2.1%, p < 0.001) for SDD versus non-SDD. No increase in adverse events for SDD occurred in either analysis. Regression identified esophageal/gastric/intestinal diseases increased odds of early readmission or reoperation (OR 1.85, p = 0.042). Same-day discharge after pediatric laparoscopic appendectomy for non-perforated acute appendicitis continues to increase in frequency without a significant increase in adverse outcomes. SDD rates are 20-30% lower than previously published single-center studies, indicating there is a likely a larger percentage of patients that could discharge same-day. Level III.

A Proposed Patient Selection Algorithm for Total Joint Arthroplasty Same-Day Discharge from an Ambulatory Surgery Center

IntroductionIdentifying appropriate patients for same-day discharge total joint arthroplasty (TJA) is critical for maintaining optimal patient safety and outcomes. This study investigated patient outcomes after same-day discharge TJA at a single ambulatory surgery center (ASC) and proposes a TJA patient-selection algorithm based on findings and existing literature. MethodsA retrospective chart review of 660 patients was performed between July 2019 and October 2021 for all patients who underwent primary TJA in a single ASC. Successful same-day discharge (SDD), length of surgery (LOS), estimated blood loss (EBL), complications, and readmission events were recorded for each patient. There were 20 total complications in 331 primary total knee arthroplasties (TKAs) (6.0%) and 15 total complications in 329 primary total hip arthroplasties (THAs) (4.6%). ResultsThere was one direct admission to the hospital in TKA patients and four direct admissions in THA patients, making the successful SDD rate 99.7% in TKAs, 98.8% in THAs, and 99.2% overall. In the TKA cohort, body mass index (BMI) was associated with total complications (r = -0.15, P = 0.006), comorbidities with wound complications (P = 0.006), and EBL was with readmissions (r = 0.30, P < 0.001), revision surgery (r = 0.12, P = 0.04), and total complications (r = 0.16, P = 0.03). In the THA cohort, BMI was weakly associated with wound complications (r = -0.12, P = 0.02), EBL was with emergency department visits (r = 0.18, P = 0.002) and total complications (r = 0.14, P = 0.01). However, there was no direct association between any of the analyzed characteristics and direct admission. ConclusionIn our ASC cohort, patients had low rates of perioperative complications and hospital admissions, supporting the safety of same-day discharge TJA using our proposed evidence-based algorithm to guide patient selection for same-day discharge.

L'angioplastie du Tronc commun gauche en ambulatoire : Comment s'y prendre ?

The steady development of same-day discharge (SDD) PCIs in recent years means that, by 2024, we will be able to tackle increasingly complex lesions, including those of the left main artery. This strategy is supported by the literature, but requires an appropriate patient selection (based on medical and social criteria) and precise assessment of the anatomical complexity of the lesion and the foreseeable risks of the PCI. Strict adherence to pre-established service protocols for patient preparation and follow-up, as well as the establishment of clinical and paraclinical criteria for discharge to a conventional hospital unit, are essential to the success of an SDD PCI program.

Safety and feasibility of same-day discharge in robotic hysterectomy and staging for endometrial cancer: A multicenter review

Safety and feasibility of same-day discharge in robotic hysterectomy and staging for endometrial cancer: A multicenter review

Editorial Comment on "Trends and Safety of Same-Day Discharge for Robot-Assisted Laparoscopic Prostatectomy: a Comparison between the Pre-Pandemic and Pandemic Periods from the National Cancer Database"

Editorial Comment on "Trends and Safety of Same-Day Discharge for Robot-Assisted Laparoscopic Prostatectomy: a Comparison between the Pre-Pandemic and Pandemic Periods from the National Cancer Database"

Same-day discharge after atrial fibrillation ablation: is it equally safe?

Abstract Introduction Same-day discharge after atrial fibrillation (AF) ablation represents a paradigm shift in post-procedure care. This approach allows patients (pts) to return home on the same day after their ablation, promoting comfort and reducing hospitalization duration. Purpose To evaluate safety of same-day discharge in pts submitted to either pulsed field ablation (PFA) or cryoablation (CA). Methods Single-center retrospective study of AF pts submitted to ablation with either PFA or CA from May 2019 to November 2023. Ablation strategy consisted in pulmonary vein isolation complemented with ablation of the cavo-tricuspid isthmus in pts with history of atrial flutter. Pts were considered eligible to same-day discharge if an observation period of at least 6h was assured after the procedure. Safety was defined as 30-day major or minor complications. Chi-square tests were used for the comparison of continuous variables. Results We included 152 pts, 60 were submitted to PFA and 92 to CA, 56.6% males, median age 66±14 years, mean CHA2DS2-VASc score 2.45±1.4. Paroxysmal AF, short and long-standing persistent AF were present in 67%, 16% and 15% of pts respectively. Previous stroke was present in 8.7% of pts and 27 pts had history of heart failure. Acute success rate was 99.3%, concomitant cavo-tricuspid isthmus ablation was performed in 20% of pts, and mean procedure time was 107.5±74 min. Same-day discharge was initially considered in 70% of pts, however of these, 12 pts remained under further observation due to acute complications. No major or minor acute complications were reported in pts with same-day discharge. There were no significant differences in 30 days complications between groups. At 30 days no major complications were reported in pts with same-day discharge. One pts in which same-day discharge was halted died 4 days after ablation from hemorrhagic shock. Regarding minor complications at 30 days, 4 minor femoral hematoma were reported, 2 in each group. Conclusion In our population, same-day discharge proved to be a safe strategy if careful pts selection is assured. This practice enhances overall pt experience, marking a significant paradigm shift in AF management.

Implementing a novel selection criteria and pathway for same-day discharge after TAVI

Abstract Background The expansion in indications for transcatheter aortic valve implantation (TAVI) has fuelled an increase in demand worldwide. Prolonged waiting lists and waiting list mortalities are not infrequent and often arise from limited hospital capacity and infrastructure. Approaches to address this have included procedural modifications – ‘minimalist TAVI’ and more recently the development of pathways to facilitate early discharge post-TAVI, such as same-day discharge (SDD) post-procedure. Purpose This study aims to evaluate the safety and effectiveness of a novel SDD pathway a large volume tertiary referral cardiac centre. Methods A new SDD pathway was established between March 2023 and February 2024 at a large-volume tertiary cardiac centre in UK. All patients accepted for TAVI were screened for SDD suitability based on three factors: 1) availability of adequate social support, (defined as presence of able-bodies adult individual to assist in home recovery), 2) technically suitable for transfemoral approach and 3) presence of previous pacemaker or low risk for conduction abnormalities (defined as no baseline conduction disturbances). Following TAVI, patients were deemed suitable for SDD if they were clinically stable, the procedure was technically successful and there were no procedural complications. Demographic, clinical, procedural and outcome data were collected for all patients enrolled onto the SDD pathway and reasons for non-SDD were identified. Ethical approval was obtained in accordance with local institutional policies. Results From March 2023 to February 2024, 81 out of 305 patients (26.6%) were enrolled onto the SDD pathway (median age 82 years old, 66.7% male, median STS risk score 2.34%). Indications for TAVI were severe native aortic stenosis (74/81, 91.4%), severe native aortic regurgitation (2/81, 2.5%) and severe surgical valve degeneration (5/81, 6.2%). SDD was feasible for 58/81 (71.6%) of patients, with 10/81 (12.3%) discharged the following day and 13/81 (16.0%%) requiring &amp;gt;24 hours hospital admission (Figure 1). Reasons for non-SDD included new conduction abnormality (10/81, 12.3%), vascular complication (6/81, 7.4%), acute stroke (3/81, 3.7%), patient preference (2/81, 2.5%) and haemodynamic instability (2/81, 2.5%). Out of the 58 SDD patients, 25/58 (43.1%) had no previous permanent pacemaker system and in these patients a balloon-expandable valve was selected for 24/25 (96.0%) of patients (Figure 2). Conclusions Patient selection based on the presence of social support at home, low risk of conduction abnormalities or previous pacemaker combined with appropriate valve selection can facilitate a safe and effective SDD post-TAVI programme.

Early discharge following cardiac implantable electronic device implantation: a systematic review and meta-analysis

Abstract Background As the demand for cardiac implantable electronic device (CIED) placement rises, healthcare expenses, including the post-procedure hospital stay costs, have been on the increase. This systematic review and meta-analysis were undertaken to evaluate the safety and viability of same-day discharge (SDD) following cardiac device implantations. Methods We conducted a systematic searched of PubMed, Embase and Cochrane database during November 2023 for studies comparing SDD versus discharge after overnight stay (OS) after CIED. Outcomes included all-cause mortality and complications after the procedure (lead/device dislodgment, re-hospitalization, pneumothorax, local hematoma and wound complications). Data from each study were combined using the random-effects model to calculate pooled odds ratio (OR) with 95% confidence interval (CI). Results Eleven studies, including two randomized clinical trials, were incorporated, with a total of 64,646 patients, providing 918 pooled death events (74 in SDD and 844 in OS). The meta-analysis revealed that SDD was associated with a significantly lower risk of all-cause mortality compared to OS (pooled HR 0.72; 95% CI: 0.55-0.93; I2=0%) and no difference was found regarding re-hospitalization (pooled HR 0.96; 95% CI: 0.88-1.05; I2 55%). SSD was not associated with higher lead/device dislodgement (pooled HR 0.93; 95% CI: 0.50-1.71; I2=0%), pneumothorax (pooler HR 1.04; 95% CI: 0.31-3.50; I2 0%) and wound complications (pooled HR 0.65; 95% CI 0.22-1.01; I2 0%). SSD was associated with more episodes of local hematoma (pooled HR 0.31; 95% CI 0.09-1.05; I2 0%). Conclusion Our meta-analysis suggests that SDD is associated with a decreased all-cause mortality compared to OS. Although associated with more episodes of local hematoma, SDD was not significantly different regarding lead/device dislodgment, pneumothorax, re-admissions and wound complications. SDD after CIED appears to be a safe and feasible alternative.

Minimally invasive hysterectomy same-day discharge: systematic review and meta-analysis of predictors.

Same-day discharge (SDD) is increasingly prevalent following minimally invasive hysterectomy (MIH). However, consensus guidelines for selecting SDD eligibility criteria for MIH remain unexplored. This study aims to identify predictive factors for non-SDD following MIH (registered in PROSPERO CRD42022350373). PubMed, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials. All original studies that involve patients who were discharged on the same day are compared with those who were not (not failure to discharge / not intended to discharge). Categorical and continuous variables were reported as risk ratios with 95% confidence intervals and weighted mean differences with 95% CIs, respectively. Heterogeneity among the included studies was assessed using the I2 statistics. We conducted sensitivity analysis to identify the reason(s) for this heterogeneity. Ten studies (59,589 patients) were included, with a mean SDD rate of 20.28%. The predictors of overnight observation included factors such as American Society of Anesthesiologists classification (ASA) > II (P = .02; I2 = 92%), increased estimated blood loss (EBL) (P < 0.00001; I2 = 87%), surgeries starting later in the day (P < 0.00, I2 = 15%), and longer operation times (P = .002; I2 = 96%). In sensitivity and subgroup analyses, uterus weight emerged as a potential factor (P < 0.00; I2 = 50%), while the results concerning ASA, uterine weight, and EBL appeared to be homogeneous. However, the operation time remained heterogeneous. These factors could assist surgeons in the decision-making process regarding the performance of SDD subsequent to MIH procedures for patients.

Trends and predictors of cardiac rehabilitation referrals and participation in patients undergoing elective percutaneous coronary intervention

Abstract Background Research evidence shows that greater cardiac rehabilitation (CR) referrals and participation can reduce cardiovascular mortality and morbidity, which leads to social and economic benefits (1). It remains unknown, however, what the CR referrals and participation are for patients following elective percutaneous coronary intervention (PCI). Aim Our aim was to identify the prevalence, trends, and predictors of CR referrals and participation in patients undergoing elective PCI between July 2017 and December 2021 among six public hospitals in one of the Australian states. Methods A retrospective observational study was conducted. Data were extracted from a state-wide Cardiac Outcomes Registry for patients who underwent elective PCI. Patients were identified if they were referred to CR following hospital discharge. CR participation has two assessments. The initial assessment focuses on a comprehensive cardiovascular risk factor review that occurs before attending a CR program, whereas the final assessment represents CR completion. We conducted descriptive and inferential statistical analyses. Results Out of 3081 patients who underwent elective PCI, 1845 (59.9%) had CR referrals. Of the 1845 patients who had CR referred, 1022 (55.4%) completed an initial assessment, and 400 (21.7%) completed both an initial and final assessment. The rate of CR referrals increased from 12.0% in 2017 to 23.5% in 2018 before decreasing slightly in 2019 and 2020 (21.0% and 22.8%, respectively). There was a decline in the proportion of patients who had an initial assessment from 44.0% in 2017 to 29.0% in 2021. The rate of the final assessment showed a slight increase from 32% in 2017 to 41% in 2021. Multivariate logistic regression showed that of those patients undergoing PCI, patients who stayed overnight were 9.9 times more likely to receive a CR referral than those with same-day discharge. However, for those who had CR referrals, overnight stay was not a predictor in completing the initial assessment. Similarly, of those who completed an initial assessment, overnight stay was also not a predictor in completing the final assessment; rather, those with a positive family history were more likely to complete the final assessment. Conclusion Our findings reveal a low CR referral rate in patients undergoing elective PCI, and overnight stay is a strong predictor for CR referrals. As a referral is a gateway to CR participation (2), more work is needed to explore the options to increase CR referrals, particularly for patients discharged on the same day as their procedure. Following referrals, overnight stay did not predict completion of initial and final assessments, indicating that other strategies are required to promote CR participation.

Same-day discharge following lumbar spine neural decompression

IntroductionThe concept of same-day discharge following lumbar spine surgery for neural elements decompression, introduced in the 1980 s, represents a significant paradigm shift in postoperative care, offering potential benefits in terms of efficiency, convenience, and cost-effectiveness. However, concerns regarding patient safety and complications have persisted. This study aims to assess same-day discharge rates following lumbar spine decompression surgery, identify preoperative predictors, and compare outcomes between same-day discharge and hospitalization. MethodsA retrospective comparative analysis was conducted using data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) Participant Use File spanning 2016 to 2021. A total of 58,430 patients undergoing lumbar spine decompression procedures were included. Statistical analysis was performed using SPSS software, with significance determined at p < 0.05. ResultsSignificant differences were observed in preoperative factors, operative variables, and postoperative outcomes between patients discharged on the same day and those hospitalized. Preoperative comorbidities, operative time, length of stay, utilization of minimally invasive approaches, and 30-day mortality rates differed significantly between the two groups. Notably, same-day discharge demonstrated superior outcomes, with lower rates of unplanned intubation, readmission, and reoperation compared to hospitalization. ConclusionIn conclusion, same-day discharge following lumbar spine decompression procedures holds promise as a safe and effective practice, offering advantages in terms of patient outcomes and healthcare resource utilization. Further research and implementation of standardized protocols are warranted to maximize the benefits of same-day discharge while ensuring patient safety and satisfaction.

Minimalist approach to left atrial appendage occlusion through three-dimensional intracardiac echocardiography: Procedural steps and single-center experience

Atrial fibrillation (AF), the most prevalent arrhythmia worldwide, is associated with an annual risk of ischemic stroke of up to 5%, with approximately 98% of thrombi originating from the left atrial appendage (LAA). Direct oral anticoagulants or vitamin K antagonists remain the gold standard for preventing systemic thromboembolism in patients with AF. LAA occlusion (LAAO) is an alternative stroke prevention technique for patients with AF who cannot tolerate long-term anticoagulation. Percutaneous LAAO typically employs a multimodal imaging approach with contrast fluoroscopy and transesophageal echocardiography (TEE) for visualization, device selection and deployment, and complication monitoring. TEE is also used for follow-up imaging. However, it necessitates general anesthesia or deep sedation and is associated with a high risk of adverse events. Three-dimensional intracardiac echocardiography (3D ICE) has been proposed as a viable alternative to TEE for LAAO procedures. In this review, we summarized the current evidence regarding ICE guidance in LAAO procedures. We also presented a case series of consecutive patients presenting at our center who underwent LAAO, which was performed by a single operator using a minimalist approach of moderate sedation, 3D ICE, and same-day discharge. We also presented a summary of the minimalist approach to LAAO using 3D ICE and detailed procedural steps of 3D ICE catheter manipulation for successful LAAO intervention.