Factors associated with same-day discharge after catheter ablation procedures for supraventricular tachycardia in Ontario, Canada

Background — Variation exists in the practice of same-day discharge (SDD) after supraventricular tachycardia (SVT) catheter-ablation procedures. The aim of this study was to evaluate factors associated with SDD after SVT catheter-ablation procedures.

Methods — All Ontario residents aged > 18 years undergoing a first-ever SVT ablation procedure between April 1, 2011 and May 31, 2020 were included. The rate of SDD at each hospital and the annual rate within Ontario were determined. A series of logistic regression models were created to determine the influence of clinical and procedural characteristics, and of the hospital performing the procedure, on the probability of SDD occurring. The median odds ratio was calculated to estimate the variation in the odds of similar patients receiving SDD at different hospitals.

Results — The cohort included 16,044 individuals (aged 55.9 ± 16.5 years; female: 45.9%). Transseptal catheterization was performed in 7.8% of the cohort. The rate of SDD increased from 61% in 2011 to 91% in 2020. Hospital rates of SDD ranged from 41% to 95%. The discrimination ability (measured by C-statistics) in predicting SDD was high, at 0.84, in the model that included the hospital, as opposed to 0.58 in the model that did not include the hospital. After adjusting for age, sex, patient comorbidities, the arrhythmia diagnosis, and procedural details, the median odds ratio attributed to the hospital performing the procedure was 3.82.

Conclusions — Variation in SDD after SVT ablation procedures is primarily related to hospital factors. Policymakers are encouraged to explore hospital-level barriers to adopting this approach.