Skip to main content
SpringerLink
Log in

Cost-effectiveness and Outcomes with Early or Same-Day Discharge After Elective Percutaneous Coronary Intervention

  • Ischemic Heart Disease (D Mukherjee, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Shorter hospital stay after percutaneous coronary intervention (PCI) can provide economic advantage. Same-day discharge (SDD) after transradial PCI is thought to reduce the cost of care while maintaining the quality and safety. This review summarizes the current knowledge of the benefits and safety of this concept.

Recent Findings

Increase in rate of transradial PCI over the last two decades has resulted in recent growth in rate of acceptance of SDD after a successful procedure. SDD is shown to result in savings of $3500 to $5200 per procedure with comparable adverse event rate of traditional discharge processes.

Summary

SDD after PCI is shown to be safe and results in cost advantage maintaining the safety profile. The acceptance rate of SDD is still not optimum, and further market penetration of SDD practice would be achieved only if the institutional and operator preference barriers are addressed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Amin AP, Pinto D, House JA, Rao SV, Spertus JA, Cohen MG, et al. Association of same-day discharge after elective percutaneous coronary intervention in the United States with costs and outcomes. JAMA Cardiol. 2018;3:1041–9 Large observational cohort study with 672,470 patients that looked at the safety of same day discharge and the savings related to same-day discharge after percutaenous coronary intervention.

    Article  Google Scholar 

  2. Sheehy AM, Caponi B, Gangireddy S, Hamedani AG, Pothof JJ, Siegal E, et al. Observation and inpatient status: clinical impact of the 2-midnight rule. J Hosp Med. 2014;9:203–9.

    Article  Google Scholar 

  3. Madan M, Bagai A, Overgaard CB, Fang J, Koh M, Cantor WJ, et al. Same-day discharge after elective percutaneous coronary interventions in Ontario, Canada. J Am Heart Assoc. 2019;8:e012131.

    Article  Google Scholar 

  4. Amin AP, Patterson M, House JA, Giersiefen H, Spertus JA, Baklanov DV, et al. Costs associated with access site and same-day discharge among Medicare beneficiaries undergoing percutaneous coronary intervention: an evaluation of the current percutaneous coronary intervention care pathways in the United States. JACC Cardiovasc Interv. 2017;10:342–51.

    Article  Google Scholar 

  5. • Rodriguez-Araujo G, Cilingiroglu M, Mego D, Hakeem A, Lendel V, Cawich I, et al. Same versus next day discharge after elective transradial PCI: the RAdial SAme Day DischArge after PCI trial. (the RASADDA-PCI trial). Cardiovasc Revasc Med. 2018;19:7–11 Trial that directly compared the safety outcomes and cost savings of same-day surgery strategy with overnight stay after percutaneous coronary intervention with a propensity matched analysis.

    Article  Google Scholar 

  6. Amin AP, Kulkarni H, Spertus JA. Same-day discharge after percutaneous coronary intervention-an elusive bargain-reply. JAMA Cardiol. 2019;4:496.

    Article  Google Scholar 

  7. Amin AP, Crimmins-Reda P, Miller S, Rahn B, Caruso M, Pierce A, et al. Novel patient-centered approach to facilitate same-day discharge in patients undergoing elective percutaneous coronary intervention. J Am Heart Assoc. 2018;7:e005733.

  8. •• Seto AH, Shroff A, Abu-Fadel M, Blankenship JC, Boudoulas KD, Cigarroa JE, et al. Length of stay following percutaneous coronary intervention: an expert consensus document update from the society for cardiovascular angiography and interventions. Catheter Cardiovasc Interv. 2018;92:717–31 Comprehensive review that provides consensus recommendation on length of stay following percutaneous coronary intervention and clarifies the reimbursement definitions of different discharge strategies and explains the reason for the safety of reduced hospitalization.

    Article  Google Scholar 

  9. Blankenship JC, Choi JW, Das TS, McElgunn PM, Mukherjee D, Paxton LL, et al. SCAI/ACVP expert consensus statement on cardiovascular catheterization laboratory economics: if the cath lab is your home you should understand its finances: this statement was endorsed by the Alliance of Cardiovascular Professionals (ACVP) in April 2019. Catheter Cardiovasc Interv. 2019;94:123–35.

    PubMed  Google Scholar 

  10. Singh VR, Jayaraman B, Satheesh S, Ananthakrishna PA. Safety and outcomes of day care based coronary angioplasty--first report from India. Indian Heart J. 2015;67:108–13.

    Article  Google Scholar 

  11. Saad Y, Shugman IM, Kumar M, Pauk I, Mussap C, Hopkins AP, et al. Safety and efficacy of same-day discharge following elective percutaneous coronary intervention, including evaluation of next day troponin T levels. Heart Lung Circ. 2015;24:368–76.

    Article  Google Scholar 

  12. Abdelaal E, Rao SV, Gilchrist IC, Bernat I, Shroff A, Caputo R, et al. Same-day discharge compared with overnight hospitalization after uncomplicated percutaneous coronary intervention: a systematic review and meta-analysis. JACC Cardiovasc Interv. 2013;6:99–112.

    Article  Google Scholar 

  13. Heyde GS, Koch KT, de Winter RJ, Dijkgraaf MG, Klees MI, Dijksman LM, et al. Randomized trial comparing same-day discharge with overnight hospital stay after percutaneous coronary intervention: results of the elective PCI in outpatient study (EPOS). Circulation. 2007;115:2299–306.

    Article  Google Scholar 

  14. Bertrand OF, De Larochelliere R, Rodes-Cabau J, Proulx G, Gleeton O, Nguyen CM, et al. A randomized study comparing same-day home discharge and abciximab bolus only to overnight hospitalization and abciximab bolus and infusion after transradial coronary stent implantation. Circulation. 2006;114:2636–43.

    Article  CAS  Google Scholar 

  15. Banning AP, Ormerod OJ, Channon K, McKenna CJ, Orr W, Boulton B, et al. Same day discharge following elective percutaneous coronary intervention in patients with stable angina. Heart. 2003;89:665.

    Article  CAS  Google Scholar 

  16. Khatri S, Webb JG, Carere RG, Amis A, Woolcott J, Chugh S, et al. Safety and cost benefit of same-day discharge after percutaneous coronary intervention. Am J Cardiol. 2002;90:425–7.

    Article  Google Scholar 

  17. Brayton KM, Patel VG, Stave C, de Lemos JA, Kumbhani DJ. Same-day discharge after percutaneous coronary intervention: a meta-analysis. J Am Coll Cardiol. 2013;62:275–85.

    Article  Google Scholar 

  18. Rubimbura V, Rostain L, Duval AM, Akakpo S, Boukantar M, Boiron P, et al. Outcomes and safety of same-day discharge after percutaneous coronary intervention: a 10-year single-center study. Catheter Cardiovasc Interv. 2019;94:105–11.

    Article  Google Scholar 

  19. Bundhun PK, Soogund MZ, Huang WQ. Same day discharge versus overnight stay in the hospital following percutaneous coronary intervention in patients with stable coronary artery disease: a systematic review and meta-analysis of randomized controlled trials. PLoS One. 2017;12:e0169807.

    Article  Google Scholar 

  20. Taxiarchi P, Kontopantelis E, Martin GP, Kinnaird T, Curzen N, Banning AP, et al. Same-day discharge after elective percutaneous coronary intervention: insights from the British Cardiovascular Intervention Society. JACC Cardiovasc Interv. 2019;12:1479–94.

    Article  Google Scholar 

  21. Hodkinson EC, Hanratty CG, Spence MS, Walsh SJ. Same day discharge after PCI can also be safe in high risk patients and acute coronary syndrome. Heart Lung Circ. 2015;24:1233.

    Article  Google Scholar 

  22. Sawant AC, Seibolt L, Distler E, Sultan M, Desai S, Gade V, et al. Safety and feasibility of same-day discharge after percutaneous coronary intervention for chronic total occlusion: a single center observational cohort study. Coron Artery Dis. 2019;30:549–50.

    Article  Google Scholar 

  23. Shlofmitz E, Jeremias A, Goldberg A, Pappas T, Berke A, Petrossian G, et al. Safety of same-day discharge after percutaneous coronary intervention with orbital atherectomy. Cardiovasc Revasc Med. 2019;20:573–6.

    Article  Google Scholar 

  24. Chen Y, Marshall A, Lin F. Lessons learnt from the implementation of same-day discharge after percutaneous coronary intervention. Aust Crit Care. 2019;32:458–464.

  25. Allen B. Effective design, implementation and management of change in healthcare. Nurs Stand. 2016;31:58–71.

    Article  Google Scholar 

  26. Longenecker CO, Longenecker PD. Why hospital improvement efforts fail: a view from the front line. J Healthc Manag. 2014;59:147–57.

    PubMed  Google Scholar 

  27. Geerligs L, Rankin NM, Shepherd HL, Butow P. Hospital-based interventions: a systematic review of staff-reported barriers and facilitators to implementation processes. Implement Sci. 2018;13:36.

    Article  Google Scholar 

  28. Mols RE, Hald M, Vistisen HS, Lomborg K, Maeng M. Nurse-led motivational telephone follow-up after same-day percutaneous coronary intervention reduces readmission and contacts to general practice. J Cardiovasc Nurs. 2019;34:222–30.

    Article  Google Scholar 

  29. Chen Y, Lin F, Marshall A. Implementing same day discharge following percutaneous coronary intervention: a process evaluation. J Nurs Care Qual. 2019;34:54–60.

    Article  Google Scholar 

  30. Agarwal S. Impact of travel time on same-day discharge after elective percutaneous coronary intervention. Tex Heart Inst J. 2017;44:431.

    Article  Google Scholar 

  31. Graziano FD, Banga S, Busman DK, Muthusamy P, Wohns DH. Barriers to early discharge after elective percutaneous coronary intervention (BED PCI): a single-center study. Indian Heart J. 2017;69:217–22.

    Article  Google Scholar 

  32. Karrowni W, Vyas A, Giacomino B, Schweizer M, Blevins A, Girotra S, et al. Radial versus femoral access for primary percutaneous interventions in ST-segment elevation myocardial infarction patients: a meta-analysis of randomized controlled trials. JACC Cardiovasc Interv. 2013;6:814–23.

    Article  Google Scholar 

  33. Chambers CE, Dehmer GJ, Cox DA, Harrington RA, Babb JD, Popma JJ, et al. Defining the length of stay following percutaneous coronary intervention: an expert consensus document from the Society for Cardiovascular Angiography and Interventions. Endorsed by the American College of Cardiology Foundation. Catheter Cardiovasc Interv. 2009;73:847–58.

    Article  Google Scholar 

  34. Shroff A, Kupfer J, Gilchrist IC, Caputo R, Speiser B, Bertrand OF, et al. Same-day discharge after percutaneous coronary intervention: current perspectives and strategies for implementation. JAMA Cardiol. 2016;1:216–23.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. JT and Margaret Talkington Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, USA

    Santhosh K. G. Koshy & Lekha K. George

  2. Division of Cardiology, Department of Internal Medicine, University of Tennessee Health Sciences Center, Memphis, TN, USA

    Pranab Das

Authors
  1. Santhosh K. G. Koshy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lekha K. George
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Pranab Das
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Santhosh K. G. Koshy.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Ischemic Heart Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Koshy, S.K.G., George, L.K. & Das, P. Cost-effectiveness and Outcomes with Early or Same-Day Discharge After Elective Percutaneous Coronary Intervention. Curr Cardiol Rep 22, 42 (2020). https://doi.org/10.1007/s11886-020-01286-1

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-020-01286-1

Keywords

Search

Navigation