Helmsley Electrophysiology Center, Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Pacing Clin Electrophysiol. 2021 Apr;44(4):711-719. doi: 10.1111/pace.14217. Epub 2021 Mar 15.
Same-day discharge (SDD) after atrial fibrillation (AF) ablation is increasingly being considered. This study examined the barriers and financial impact associated with SDD in a contemporary cohort of patients undergoing elective AF ablation.
A single center retrospective review was conducted of the 249 first case-of-the-day outpatient AF ablations performed in 2019 to evaluate the proportion of patients that could have undergone SDD. Barriers to SDD were defined as any intervention that prevented SDD by 8 p.m. The financial impact of SDD was based on savings from avoidance of the overnight hospital stay and revenue related to management of chest pain facilitated by a vacant hospital bed.
SDD could have occurred in 157 patients (63%) without change in management and in up to 200 patients (80%) if avoidable barriers were addressed. Barriers to SDD included non-clinical logistical issues (43%), prolonged post-procedure recovery (42%) and minor procedural complications (15%). On multivariate analysis, factors associated with barriers to SDD included increasing age (P = .01), left ventricular ejection fraction ≤ 35% (P = .04), and severely dilated left atrium (P = .04). The financial gain from SDD would have ranged from $1,110,096 (assuming discharge of 63% of eligible patients) to $1,480,128 (assuming 80% discharge) over the course of a year.
Up to 80% of patients undergoing outpatient AF ablation were amenable to SDD if avoidable delays in care had been anticipated. Based on reduced hospital operating expenses and increased revenue from management of individuals with chest pain, this would translate to a financial savings of ∼$1.5 million.
越来越多的人考虑在心房颤动（AF）消融术后当天出院（SDD）。本研究在接受择期 AF 消融的当代患者队列中检查了 SDD 相关的障碍和经济影响。
对 2019 年 249 例首日门诊 AF 消融的单中心回顾性研究，以评估可能进行 SDD 的患者比例。SDD 的障碍定义为任何可能导致 8 点前不能 SDD 的干预措施。SDD 的经济影响基于避免过夜住院的节省以及通过空床位方便管理胸痛而产生的收入。
在不改变管理的情况下，157 例患者（63%）可以进行 SDD，如果避免可避免的障碍，则多达 200 例患者（80%）可以进行 SDD。SDD 的障碍包括非临床后勤问题（43%）、术后恢复时间延长（42%）和轻微手术并发症（15%）。多变量分析显示，与 SDD 障碍相关的因素包括年龄增加（P = 0.01）、左心室射血分数≤35%（P = 0.04）和左心房严重扩张（P = 0.04）。如果预计避免护理延迟，SDD 的经济效益将在一年中从 111 万美元（假设 63%符合条件的患者出院）到 148 万美元（假设 80%出院）不等。
如果提前预料到护理中的可避免延迟，80%的门诊接受 AF 消融术的患者可以当天出院。基于减少医院运营费用和管理胸痛患者的收入增加，这将转化为约 150 万美元的财务节省。
