Prevalence and outcomes of same-day discharge after elective percutaneous coronary intervention among older patients.

Published

Journal Article

CONTEXT: Patients undergoing elective percutaneous coronary intervention (PCI) are generally observed overnight in the hospital. The association between same-day discharge of older patients and death or readmission is unclear. OBJECTIVE: To evaluate the prevalence and outcomes of same-day discharge among older patients undergoing elective PCI in the United States. DESIGN, SETTING, AND PARTICIPANTS: Multicenter cohort study. Data were from 107,018 patients 65 years or older undergoing elective PCI procedures at 903 sites participating in the CathPCI Registry between November 2004 and December 2008 and were linked with Medicare Part A claims. Patients were divided into 2 groups based on their length of stay after PCI: same-day discharge or overnight stay. MAIN OUTCOME MEASURES: Death or rehospitalization occurring within 2 days and by 30 days after PCI. RESULTS: The prevalence of same-day discharge was 1.25% (95% CI, 1.19%-1.32%; n = 1339 patients) with significant variation across facilities. Patient characteristics were similar between the 2 groups, although same-day discharge patients underwent shorter procedures with less multivessel intervention. There were no significant differences in the rates of death or rehospitalization at 2 days (same-day discharge, 0.37% [95% CI, 0.16%-0.87%] vs overnight stay, 0.50% [95% CI, 0.46%-0.54%]; P = .51) or at 30 days (same-day discharge, 9.63% [95% CI, 8.17%-11.33%] vs overnight stay, 9.70% [95% CI, 9.52%-9.88%]; P = .94). Among patients with adverse outcomes, the median time to death or rehospitalization did not differ significantly between the groups (same-day discharge, 13 days [interquartile range, 7.0-21.0] vs overnight stay, 14 days [interquartile range, 7.0-21.0]; P = .96). After adjustment for patient and procedure characteristics, same-day discharge was not significantly associated with 30-day death or rehospitalization (adjusted odds ratio, 0.95 [95% CI, 0.78-1.16]). CONCLUSION: Among selected low-risk Medicare patients undergoing elective PCI, same-day discharge is rarely implemented but is not associated with death or rehospitalization compared with overnight observation.

Full Text

Duke Authors

Cited Authors

  • Rao, SV; Kaltenbach, LA; Weintraub, WS; Roe, MT; Brindis, RG; Rumsfeld, JS; Peterson, ED

Published Date

  • October 5, 2011

Published In

Volume / Issue

  • 306 / 13

Start / End Page

  • 1461 - 1467

PubMed ID

  • 21972308

Pubmed Central ID

  • 21972308

Electronic International Standard Serial Number (EISSN)

  • 1538-3598

Digital Object Identifier (DOI)

  • 10.1001/jama.2011.1409

Language

  • eng

Conference Location

  • United States