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. 2019 Jul 2;8(13):e012131.
doi: 10.1161/JAHA.119.012131. Epub 2019 Jun 24.

Same-Day Discharge After Elective Percutaneous Coronary Interventions in Ontario, Canada

Mina Madan  1 , Akshay Bagai  2 , Christopher B Overgaard  3 , Jiming Fang  4 , Maria Koh  4 , Warren J Cantor  5   6 , Pallav Garg  7 , Madhu K Natarajan  8 , Derek Y F So  9 , Dennis T Ko  1   4
Affiliations

Same-Day Discharge After Elective Percutaneous Coronary Interventions in Ontario, Canada

Mina Madan et al. J Am Heart Assoc. .

Abstract

Background To manage overcrowding and bed shortages in Canadian hospitals, same-day discharge (SDD) after percutaneous coronary intervention (PCI) has emerged as a solution to improve resource utilization. However, limited information exists regarding current trends, hospital variation, and safety of SDD PCI in Canada. Methods and Results We evaluated outpatients undergoing elective PCI in Ontario, Canada, from October 2008 to March 2016. SDD was defined when patients were discharged on the day of PCI, and non-SDD was defined as those patients who had 1 overnight stay. The primary outcome was 30-day all-cause death or hospitalization for acute coronary syndrome. Inverse probability of treatment weighting with propensity score was used to account for differences in baseline and clinical characteristics between SDD and non-SDD groups. Among 35 972 patients who underwent elective PCI at 17 PCI centers in Ontario, 10 801 patients (30%) had SDD PCI and 25 121 patients (70%) had non-SDD PCI. Substantial hospital variation for SDD PCI was observed, ranging from 0% to 87% during the study period. In the propensity-weighted cohort, SDD patients had no significant difference in 30-day rates of death or hospitalization for acute coronary syndrome (1.3% versus 1.6%; hazard ratio: 0.84 [95% CI, 0.65-1.08]; P=0.17) compared with non-SDD patients. SDD and non-SDD patients also had no significant difference in 30-day rates of mortality or coronary revascularization. Conclusions In this large population-based cohort of elective PCI patients, we demonstrated the safety of SDD PCI. Increased adoption of this strategy could lead to improved bed-flow efficiency and substantial savings for the Canadian healthcare system without comprising outcomes.

Keywords: discharge; healthcare costs; hospital stay; percutaneous coronary intervention; variation.

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Figures

Figure 1
Figure 1
Cohort selection. PCI indicates percutaneous coronary intervention.
Figure 2
Figure 2
Overall hospital variation in outpatient same‐day procedures, 2008–2015. PCI indicates percutaneous coronary intervention.
Figure 3
Figure 3
Trend in same‐day discharge (SDD) in Ontario, 2008–2015.
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