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经皮冠状动脉介入治疗后当日出院:当前的观点和实施策略。

Same-Day Discharge After Percutaneous Coronary Intervention: Current Perspectives and Strategies for Implementation.

机构信息

Department of Medicine, University of Illinois at Chicago.

Division of Cardiology, Department of Medicine, University of Illinois College of Medicine at Peoria.

出版信息

JAMA Cardiol. 2016 May 1;1(2):216-23. doi: 10.1001/jamacardio.2016.0148.

Abstract

IMPORTANCE

The evolution of percutaneous coronary intervention (PCI) has led to improved safety and efficacy, such that overnight observation can be avoided in some patients. We sought to provide a narrative review of the current literature regarding the outcomes of same-day discharge (SDD) PCI and to describe a framework for the development of an SDD program.

OBSERVATIONS

A literature search of PubMed was performed for human studies on SDD PCI published in English from January 1, 1995, to July 31, 2015. We reviewed the studies between June and September 2015. After literature review, we included reports of randomized clinical trials, observational studies, meta-analyses guidelines, and consensus statements in a narrative review. Compared with overnight observation, there was no increase in adverse events (bleeding, repeat coronary procedures, death, or rehospitalization) among patients in these studies who were discharged on the same day of their PCI procedure. Same-day discharge was associated with significant cost savings and was preferred by patients.

CONCLUSIONS AND RELEVANCE

The available evidence supports the safety of SDD in selected patients after PCI. Specific programmatic features are important to the successful implementation of SDD after PCI. Greater adoption of SDD programs after PCI has the potential to improve patient satisfaction, increase bed availability, and reduce hospital costs without increasing adverse patient outcomes.

摘要

重要性

经皮冠状动脉介入治疗(PCI)的发展已经提高了安全性和疗效,因此可以避免某些患者进行过夜观察。我们旨在提供一篇关于经皮冠状动脉介入治疗(PCI)当日出院(SDD)的现有文献的叙述性综述,并描述 SDD 计划的制定框架。

观察结果

我们对 1995 年 1 月 1 日至 2015 年 7 月 31 日在英文期刊上发表的有关 SDD PCI 的人类研究进行了 PubMed 文献检索。我们在 2015 年 6 月至 9 月间进行了文献综述。文献回顾后,我们在叙述性综述中纳入了随机临床试验、观察性研究、荟萃分析指南和共识声明的报告。与过夜观察相比,在这些研究中,当天进行 PCI 手术出院的患者中,不良事件(出血、再次冠状动脉介入治疗、死亡或再次住院)没有增加。当日出院与显著的成本节约相关,并且患者也更喜欢当日出院。

结论和相关性

现有证据支持在特定患者中进行 PCI 后 SDD 的安全性。特定的计划特征对于 PCI 后 SDD 的成功实施非常重要。更大程度地采用 PCI 后 SDD 计划有可能改善患者满意度、增加床位供应并降低医院成本,而不会增加患者的不良预后。

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