Minneapolis Heart Institute, Minneapolis, Minnesota, USA; Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
The Duke Clinical Research Institute, Durham, North Carolina, USA.
JACC Cardiovasc Interv. 2021 Aug 9;14(15):1655-1666. doi: 10.1016/j.jcin.2021.05.043.
The aims of this study were to describe trends and hospital variation in same-day discharge following elective percutaneous coronary intervention (PCI) and to evaluate the association between trends in same-day discharge and patient outcomes.
Insights on contemporary use of same-day discharge following elective PCI are limited.
In a sequential cross-sectional analysis of 819,091 patients undergoing elective PCI at 1,716 hospitals in the National Cardiovascular Data Registry CathPCI Registry from July 1, 2009, to December 31, 2017, overall and hospital-level trends in same-day discharge were assessed. Among the 212,369 patients who linked to Centers for Medicare and Medicaid Services data, the association between same-day discharge and 30-day mortality and rehospitalization was assessed.
A total of 114,461 patients (14.0%) were discharged the same day as PCI. The proportion of patients with same-day discharge increased from 4.5% in the third quarter of 2009 to 28.6% in the fourth quarter of 2017. From 2009 to 2017, the rate of same-day discharge increased from 4.3% to 19.5% for femoral-access PCI and from 9.9% to 39.7% for radial-access PCI. Hospital-level variation in the use of same-day discharge persisted throughout (median odds ratio adjusted for year and radial access: 4.15). Risk-adjusted 30-day mortality did not change over time, while risk-adjusted rehospitalization decreased over time and more quickly for same-day discharge (P for interaction <0.001).
In the past decade, a large increase in the use of same-day discharge following elective PCI was not associated with worse 30-day mortality or rehospitalization. Hospital-level variation in same-day discharge may represent an opportunity to reduce costs without compromising patient outcomes.
本研究旨在描述择期经皮冠状动脉介入治疗（PCI）后当天出院的趋势和医院差异，并评估当天出院趋势与患者结局之间的关系。
目前对择期 PCI 后当天出院的最新使用情况了解有限。
本研究在全国心血管数据注册中心 CathPCI 注册库中，对 2009 年 7 月 1 日至 2017 年 12 月 31 日期间在 1716 家医院接受择期 PCI 的 819091 例患者进行了连续的横断面分析，评估了总体和医院层面的当天出院趋势。在与医疗保险和医疗补助服务中心数据相联系的 212369 例患者中，评估了当天出院与 30 天死亡率和再入院之间的关系。
共有 114461 例（14.0%）患者在 PCI 当天出院。当天出院的患者比例从 2009 年第三季度的 4.5%上升到 2017 年第四季度的 28.6%。从 2009 年到 2017 年，股动脉入路 PCI 的当天出院率从 4.3%上升到 19.5%，桡动脉入路 PCI 的当天出院率从 9.9%上升到 39.7%。在整个研究期间，医院层面的当天出院使用率的差异一直存在（调整年份和桡动脉入路后，中位数优势比为 4.15）。风险调整后的 30 天死亡率没有随时间而变化，而风险调整后的再入院率随时间而下降，且当天出院的下降速度更快（P 交互<0.001）。
在过去十年中，择期 PCI 后当天出院的使用率大幅增加，但与 30 天死亡率或再入院率无关。当天出院的医院层面差异可能代表了在不影响患者结局的情况下降低成本的机会。
