Amin AP, et al. - In this observational cross-sectional cohort study, researchers determined the contemporary US practice of same-day discharge (SDD) following elective percutaneous coronary intervention (PCI) in terms of incidence, variation, trends, costs, and safety outcomes. They noted SDD was uncommon following elective PCI, with considerable hospital variation from 2006 to 2015. It seems that greater and more consistent use of SDD could improve the overall value of PCI care and save US hospitals approximately $577 million in costs if adopted in the US in the bundled payment era.

Methods

• Researchers included 672,470 patients enrolled in the nationally representative Premier Healthcare Database who underwent elective PCI from 493 hospitals between January 2006 and December 2015 with 1-year follow-up in this observational cross-sectional cohort study.
• They defined same-day discharge by identical dates of admission, PCI procedure, and discharge.
• Death, bleeding requiring a blood transfusion, AKI and AMI at 30, 90, or 365 days after PCI, and costs from hospitals’ perspective, inflated to 2016 were assessed as main outcomes.

Results

• Elective PCIs were performed on 672,470 patients; among these, 221,997 patients (33.0%) were women; 30,711 (4.6%) were Hispanic; 51,961 (7.7%) were African American; and 491,823 (73.1%) were white.
• Findings revealed the adjusted rate of SDD of 3.5% (95% CI, 3.0%-4.0%), which increased from 0.4% in 2006 to 6.3% in 2015.
• For SDD, substantial hospital variation from 0% to 83% (median incidence rate ratio, 3.82; 95% CI, 3.48-4.23) was noted, implying an average (median) 382% probability of SDD at one vs another hospital.
• Among SDD (vs non-SDD) patients, no higher risk of death, bleeding, AKI, or AMI at 30, 90, or 365 days was evident.
• A large cost savings of $5,128 per procedure (95% CI, $5,006-$5,248) was evident with same-day discharge; this was driven by reduced supply and room and boarding costs.
• A shift from existing SDD practices to match top-decile SDD hospitals is expected to result in annual saving of $129 million in this sample and $577 million if adopted throughout the US.
• However, the precision of the cost estimates may be limited by the presence of residual confounding.