Same-day discharge among patients undergoing elective PCI: Insights from the VA CART Program - 02/12/19
, Colin I. O'Donnell, PhD b, Mary E. Plomondon, MSPH, PhD b, Paul L. Hess, MD, MHS b, Mark Donahue, MD a, Paul L. Hebert, PhD c, Adhir Shroff, MD, MPH d, Rajesh V. Swaminathan, MD a, Stephen W. Waldo, MD b, Arnold H. Seto, MD, MPA e, Christian D. Helfrich, MPH, PhD c, Sunil V. Rao, MD aAbstract |
Background |
Available data suggest that same-day discharge (SDD) after elective percutaneous coronary intervention (PCI) is safe in select patients. Yet, little is known about contemporary adoption rates, safety, and costs in a universal health care system like the Veterans Affairs Health System.
Methods |
Using data from the Veterans Affairs Clinical Assessment Reporting and Tracking Program linked with Health Economics Resource Center data, patients undergoing elective PCI for stable angina between October 1, 2007 and Sepetember 30, 2016, were stratified by SDD versus overnight stay. We examined trends of SDD, and using 2:1 propensity matching, we assessed 30-day rates of readmission, mortality, and total costs at 30 days.
Results |
Of 21,261 PCIs from 67 sites, 728 were SDDs (3.9% of overall cohort). The rate of SDD increased from 1.6% in 2008 to 9.7% in 2016 (P < .001). SDD patients had lower rates of atrial fibrillation, peripheral arterial disease, and prior coronary artery bypass grafting and were treated at higher-volume centers. Thirty-day readmission and mortality did not differ significantly between the groups (readmission: 6.7% SDD vs 5.6% for overnight stay, P = .24; mortality: 0% vs. 0.07%, P = .99). The mean (SD) 30-day cost accrued by patients undergoing SDD was $23,656 ($15,480) versus $25,878 ($17,480) for an overnight stay. The accumulated median cost savings for SDD was $1503 (95% CI $738-$2,250).
Conclusions |
Veterans Affairs Health System has increasingly adopted SDD for elective PCI procedures, and this is associated with cost savings without an increase in readmission or mortality. Greater adoption has the potential to reduce costs without increasing adverse outcomes.
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| Charles J. Davidson, MD, served as guest editor for this article. |
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| Funding: This analysis was supported by funding from the Veterans Affairs Clinical Assessment Reporting and Tracking Program. |
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| Disclosures: Dr Rymer was supported during the conduct of this study by an American College of Cardiology grant (William F. Keating award) and has received research grants from Boston Scientific and Abbott Vascular. Dr Shroff reports an advisory board/speaker role for Medtronic and Terumo. Dr Waldo reports research support from the Denver Research Institute from Abiomed, Cardiovascular Systems Incorporated, and Merck Pharmaceuticals. Dr Seto reports being on the speaker's bureau for Terumo. The other authors report no disclosures. |
Vol 218
P. 75-83 - décembre 2019 Retour au numéro
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