Amin AP, et al. - Authors evaluated the incidence and trends in same-day discharge (SDD) and hospital variation in SDD. They also assessed the correlation between SDD and readmissions for bleeding, acute kidney injury (AKI), acute myocardial infarction (AMI), or mortality at 30, 90, and 365 days after percutaneous coronary intervention (PCI). Furthermore, they assessed the hospital costs of SDD and its drivers. SDD after elective PCI was not frequent, yet there was considerable hospital variation over 2006 to 2015. In view of the safety and substantial savings of more than $5,000 per PCI associated with SDD, the overall value of PCI care can be increased with greater and more consistent use of SDD.

Methods

• In this observational cross-sectional cohort study, experts included 672,470 patients enrolled in the nationally representative Premier Healthcare Database who had undergone elective PCI from 493 hospitals between January 2006 and December 2015 with 1-year follow-up.
• Exposures included the same-day discharge, defined by identical dates of admission, PCI procedure, and discharge.
• Death, bleeding requiring a blood transfusion, AKI and AMI at 30, 90, or 365 days after PCI, and costs from hospitals’ perspective, inflated to 2016 were included in the main outcomes and measures.

Results

• As per data, among 672,470 elective PCIs, 221,997 patients (33.0%) were women, 30,711 (4.6%) were Hispanic, 51,961 (7.7%) were African American, and 491,823 (73.1%) were white.
• Findings suggested 3.5% to be the adjusted rate of SDD (95% CI, 3.0%-4.0%), which increased from 0.4% in 2006 to 6.3% in 2015.
• Substantial hospital variation for SDD was observed from 0% to 83% (median incidence rate ratio, 3.82; 95% CI, 3.48-4.23), implying an average (median) 382% likelihood of SDD at one vs another hospital.
• No higher risk of death, bleeding, AKI, or AMI at 30, 90, or 365 days was seen among SDD (vs non-SDD) patients.
• Results demonstrated an association of same-day discharge with a large cost savings of $5128 per procedure (95% CI, $5006-$5248), driven by reduced supply and room and boarding costs.
• In this sample, a shift from existing SDD practices to match top-decile SDD hospitals could annually save $129 million and $577 million if adopted throughout the United States.
• Nonetheless, presence of residual confounding was seen, limiting the precision of the cost estimates.