New study suggests same-day discharge after non-surgical heart procedure could save money and free up hospital beds
A new study by researchers at ICES and Sunnybrook Health Sciences Centre shows that releasing patients the same day of a percutaneous coronary intervention (PCI) versus the next day did not have any negative impacts on the patient, but could result in cost-savings and a reduction in hospital-bed use.
PCI, also known as an angioplasty, is a minimally-invasive procedure that uses a catheter (thin flexible tube) to place a small wire mesh called a stent into the heart to open up blood vessels that have been narrowed by plaque buildup.
In Ontario, more than 25,000 of these procedures are done each year.
“We know that hospital crowding is happening and patients are increasingly staying in hallways of hospitals in Ontario. Our results show that discharge the same day after angioplasty is just as safe and effective as staying an extra night. We estimate that if Ontario hospitals adopted a same-day discharge rate of 80 per cent for elective angioplasty, it could save 3,500 overnight stays each year in Ontario alone,” says Dr. Dennis Ko, senior author of the study, a scientist at ICES and an interventional cardiologist at the Schulich Heart Centre at Sunnybrook Health Sciences Centre.
Same day discharge after PCI is possible because of advances in both technology and pharmacology that have reduced the risk of post-operative heart attacks and bleeding.
The study, published today in the Journal of the American Heart Association, looked at data on all patients (35,972) in Ontario who received an elective PCI from 2008 to 2016. The study found that 10,801 patients (30 per cent) had been released the same day while 25,121 patients (70 per cent) stayed overnight in hospital. Patients released the same day as their procedure had no significant difference from patients released the following day in rates of death or heart attack at 30 days. The one-year rates for mortality were also similar in the two groups.
“We found that discharging same day versus the next day was the same in terms of outcomes, meaning there was no harm for patients and when speaking to patients, I’ve found that they are thrilled to be able to go home after the procedure and recover in their own beds. Many places in the world have adopted this, and it is great for us to show that it can be safely done in Ontario as well,” says Dr. Mina Madan, lead author on the study and interventional cardiologist at the Schulich Heart Centre at Sunnybrook Health Sciences Centre.
The study found there was significant variation in the use of same-day discharge after PCI in Ontario hospitals ranging from 0 to 87 per cent. But the researchers found that the variation was not due to a difference in patient characteristics but instead, is mainly due to adoption and/or acceptance of discharging patients home early.
Author block: Mina Madan, Akshay Bagai, Christopher B. Overgaard, Jiming Fang, Maria Koh, Warren J. Cantor, Pallav Garg, Madhu K. Natarajan, Derek Y.F. So and Dennis T. Ko.
The study “Same-day discharge after elective percutaneous coronary interventions in Ontario, Canada,” is published in the June 24 issue of Journal of the American Heart Association.
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