Featured Research

from universities, journals, and other organizations

Same-day discharge after elective PCI not associated with increased risk of death, rehospitalization, U.S. study shows

Date:
October 4, 2011
Source:
JAMA and Archives Journals
Summary:
Among selected low-risk U.S. Medicare patients who underwent an elective percutaneous coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries), same-day discharge was rarely implemented, but was not associated with an increased risk of being rehospitalized or having a higher risk of death at two days or at 30 days, than patients who remained in the hospital overnight, according to a new study.

Among selected low-risk Medicare patients who underwent an elective percutaneous coronary intervention (PCI; procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries), same-day discharge was rarely implemented, but was not associated with an increased risk of being rehospitalized or having a higher risk of death at 2 days or at 30 days, than patients who remained in the hospital overnight, according to a study in the October 5 issue of JAMA.

"Percutaneous coronary intervention is one of the most commonly performed cardiac procedures with more than 1 million episodes of care annually among Medicare recipients. Risks associated with PCI are highest within the first 24 to 48 hours after the procedure and include periprocedural myocardial infarction [MI; heart attack], acute stent thrombosis [blood clot formation within the stent], bleeding, or renal failure," according to background information in the article. "However, short- and long-term outcomes after PCI have improved because of the evolution in device technology and pharmacotherapy. Despite this improvement, patients are usually observed overnight in the hospital after elective PCI to monitor for PCI-related complications." The safety of same-day discharge among older individuals undergoing this procedure is not known. Same-day discharge would increase bed availability for the hospital and reduce medical expenses.

Sunil V. Rao, M.D., of the Duke Clinical Research Institute, Durham, N.C., and colleagues conducted a study to examine the prevalence of same-day discharge among older individuals following PCI and the rates of death or rehospitalization. The study included data 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. The primary outcomes measured were rehospitalization or death occurring within 2 days and by 30 days after PCI.

The researchers found that prevalence of same-day discharge was 1.25 percent (n = 1,339 patients), with significant variation across facilities. There was no significant difference in the rates of procedural success between the 2 groups. Patient characteristics were similar between the 2 groups, although same-day discharge patients underwent shorter procedures with less multivessel intervention. Patients who were discharged home the same day were more often categorized in the lowest quintile of predicted risk for death or rehospitalization, while there were approximately equal proportions of lower- and higher-risk patients observed overnight.

"There were no significant differences in the rates of death or rehospitalization at 2 days (same-day discharge, 0.37 percent vs. overnight stay, 0.50 percent or at 30 days (same-day discharge, 9.63 percent vs. overnight stay, 9.70 percent). Among patients with adverse outcomes, the median [midpoint] time to death or rehospitalization did not differ significantly between the groups (same-day discharge, 13 days vs. overnight stay, 14 days). After adjustment for patient and procedure characteristics, same-day discharge was not significantly associated with 30-day death or rehospitalization," the authors write.

The researchers note that despite the apparent safety of same-day discharge for selected patients, the present analysis demonstrates that this approach is rarely practiced among sites represented in the National Cardiovascular Data Registry. "This may reflect reluctance on the part of clinicians to discharge patients the same day as the PCI procedure because of concerns over early post-PCI complications. Although these concerns are well founded, the rates of vascular or bleeding complications were extremely low (less than 1 percent) among the patients in our analysis, with no clinically significant differences between groups."

"These data suggest that a proportion of low-risk patients currently observed overnight may be eligible for same-day discharge without an increase in early or intermediate-term adverse events."

The authors add that according to published guidelines, same-day discharge can be considered for patients undergoing PCI who have low-risk clinical features, successful procedures without prolonged post-procedure use of parenteral (by injection) antithrombotic agents, and adequate social support.


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. Sunil V. Rao, Lisa A. Kaltenbach, William S. Weintraub, Matthew T. Roe, Ralph G. Brindis, John S. Rumsfeld, Eric D. Peterson. Prevalence and Outcomes of Same-Day Discharge After Elective Percutaneous Coronary Intervention Among Older Patients. JAMA, 2011; 306 (13): 1461-1467 DOI: 10.1001/jama.2011.1409

Cite This Page:

JAMA and Archives Journals. "Same-day discharge after elective PCI not associated with increased risk of death, rehospitalization, U.S. study shows." ScienceDaily. ScienceDaily, 4 October 2011. <www.sciencedaily.com/releases/2011/10/111004162311.htm>.
JAMA and Archives Journals. (2011, October 4). Same-day discharge after elective PCI not associated with increased risk of death, rehospitalization, U.S. study shows. ScienceDaily. Retrieved April 19, 2014 from www.sciencedaily.com/releases/2011/10/111004162311.htm
JAMA and Archives Journals. "Same-day discharge after elective PCI not associated with increased risk of death, rehospitalization, U.S. study shows." ScienceDaily. www.sciencedaily.com/releases/2011/10/111004162311.htm (accessed April 19, 2014).

Share This



More Health & Medicine News

Saturday, April 19, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

'Holy Grail' Of Weight Loss? New Find Could Be It

'Holy Grail' Of Weight Loss? New Find Could Be It

Newsy (Apr. 18, 2014) In a potential breakthrough for future obesity treatments, scientists have used MRI scans to pinpoint brown fat in a living adult for the first time. Video provided by Newsy
Powered by NewsLook.com
Little Progress Made In Fighting Food Poisoning, CDC Says

Little Progress Made In Fighting Food Poisoning, CDC Says

Newsy (Apr. 18, 2014) A new report shows rates of two foodborne infections increased in the U.S. in recent years, while salmonella actually dropped 9 percent. Video provided by Newsy
Powered by NewsLook.com
Scientists Create Stem Cells From Adult Skin Cells

Scientists Create Stem Cells From Adult Skin Cells

Newsy (Apr. 17, 2014) The breakthrough could mean a cure for some serious diseases and even the possibility of human cloning, but it's all still a way off. Video provided by Newsy
Powered by NewsLook.com
Obama: 8 Million Healthcare Signups

Obama: 8 Million Healthcare Signups

AP (Apr. 17, 2014) President Barack Obama gave a briefing Thursday announcing 8 million people have signed up under the Affordable Care Act. He blasted continued Republican efforts to repeal the law. (April 17) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins