Agarwal Shikhar, Thakkar Badal, Skelding Kimberly A, Blankenship James C
From the Department of Cardiology, Section of Interventional Cardiology, Geisinger Medical Center, Danville, PA (S.A., K.A.S., J.C.B.); and Division of Internal Medicine, Rutgers New Jersey Medical School, Newark (B.T.).
Circ Cardiovasc Qual Outcomes. 2017 Aug;10(8). doi: 10.1161/CIRCOUTCOMES.117.003936.
Despite the demonstrated safety of the same-day discharge (SDD) after percutaneous coronary intervention (PCI), uptake of this program has been relatively poor in the United States. We evaluated the temporal trends and variations in the utilization of SDD after PCI during the contemporary era. In addition, we evaluated the predictors of SDD (compared with next-day discharge) and the causes of readmission in these 2 patient cohorts.
Data were extracted from State Ambulatory Surgical Database and State Inpatient Database from Florida and New York ranging from 2009 to 2013. All adults undergoing PCI in an outpatient setting were included. Data were merged with the directory available from the American Hospital Association to obtain detailed information on hospital-related characteristics. Unplanned readmissions within 7 and 30 days constituted the coprimary outcomes. There was modest increase in the proportion of SDD after PCI from 2.5% in 2009 to 7.4% in 2013 (-trend <0.001). SDD was more frequently used among male and younger patients with fewer comorbidities. There were considerable differences in the discharge practices among the different hospital types. Larger hospitals, teaching hospitals, and high PCI volume hospitals had higher utilization of SDD compared with their respective counterparts. SDD and next-day discharge cohorts had similar rates of unplanned readmissions, in-hospital mortality, and acute myocardial infarction during follow-up. Furthermore, uninsured patients had significantly lower odds of SDD along with higher incidence of unplanned readmission within 30 days after PCI compared with insured patients.
During 2009 to 2013, there has been a modest increase in SDD after PCI. Several demographic and clinical characteristics play critical role in determination of SDD after PCI. There were significant disparities in discharge practices between different sex, racial, and insurance-based strata.
尽管经皮冠状动脉介入治疗（PCI）后当日出院（SDD）已被证明是安全的，但该方案在美国的采用率相对较低。我们评估了当代PCI后SDD使用情况的时间趋势和变化。此外，我们评估了SDD（与次日出院相比）的预测因素以及这两组患者再入院的原因。
数据来自佛罗里达州和纽约州2009年至2013年的州门诊手术数据库和州住院数据库。纳入所有在门诊接受PCI的成年人。数据与美国医院协会提供的名录合并，以获取有关医院相关特征的详细信息。7天和30天内的非计划再入院构成共同主要结局。PCI后SDD的比例从2009年的2.5%适度增加到2013年的7.4%（趋势<0.001）。SDD在合并症较少的男性和年轻患者中使用更为频繁。不同医院类型的出院做法存在相当大的差异。与各自的同类医院相比，大型医院、教学医院和PCI手术量高的医院对SDD的利用率更高。SDD组和次日出院组在随访期间的非计划再入院率、住院死亡率和急性心肌梗死发生率相似。此外，与参保患者相比，未参保患者接受SDD的几率显著较低，且PCI后30天内非计划再入院的发生率更高。
在2009年至2013年期间，PCI后SDD有适度增加。一些人口统计学和临床特征在PCI后SDD的确定中起关键作用。不同性别、种族和保险阶层之间的出院做法存在显著差异。
