T Brown Matthew, M Pelling Mary, Kiani Soroosh, M Merchant Faisal, F El-Chami Mikhael, R Leon Angel, Westerman Stacy, Shah Anand, Wise Donna, S Lloyd Michael
Emory University Hospital, Atlanta, GA.
Emory University Hospital Midtown, Atlanta, GA.
J Atr Fibrillation. 2021 Feb 28;13(5):2466. doi: 10.4022/jafib.2466. eCollection 2021 Feb-Mar.
Head-to-head comparative data for the postoperative care of patients undergoing left atrial ablation procedures are lacking.
We sought to investigate complication and readmission rates between patients undergoing same-day (SD) or next-day (ND) discharges for ablative procedures in the left atrium, primarily atrial fibrillation (AF).
Two electrophysiology centers simultaneously perform left atrial ablations with differing discharge strategies. We identified all patients who underwent left atrial ablation from August 2017 to August 2019 (n = 409) undergoing either SD (n = 210) or ND (n = 199) discharge protocols. We analyzed any clinical events that resulted in procedural abortion, extended hospitalization, or readmission within 72 hours.
The primary endpoint of complication and readmission rate was similar between SD and ND discharge (14.3% vs 12.6%, p = 0.665). Rates of complications categorized as major (2.4% vs 3.0%, p = 0. 776) and minor (11.9% vs 9.5%, p = 0.524) were also similar.Multivariable regression modeling revealed no significant correlation between discharge strategy and complication/readmission occurrence (OR 1.565 [0.754 - 3.248], p = 0.23), but a positive association of hypertension and procedure duration (OR 3.428 [1.436 - 8.184], p = 0.006) and (OR 1.01 [1 - 1.019], p = 0.046) respectively.
Left atrial ablation complication and readmission rates were similar between SD and ND discharge practices. Hypertension and procedural duration were associated with increased complication rates irrespective of discharge strategy. These data, which represent the first side-by-side comparison of discharge strategy, suggests same-day discharge is safe and feasible for left atrial ablation procedures.
目前缺乏关于接受左心房消融手术患者术后护理的直接比较数据。
我们旨在调查接受左心房消融手术（主要是心房颤动（AF））的患者在同日（SD）或次日（ND）出院情况下的并发症和再入院率。
两个电生理中心同时进行左心房消融手术，但出院策略不同。我们确定了2017年8月至2019年8月期间接受左心房消融手术的所有患者（n = 409），他们采用了SD（n = 210）或ND（n = 199）出院方案。我们分析了任何导致手术中止、延长住院时间或72小时内再入院的临床事件。
SD和ND出院患者的并发症和再入院率这一主要终点相似（14.3%对12.6%，p = 0.665）。分类为严重（2.4%对3.0%，p = 0.776）和轻微（11.9%对9.5%，p = 0.524）的并发症发生率也相似。多变量回归模型显示出院策略与并发症/再入院发生率之间无显著相关性（比值比1.565 [0.754 - 3.248]，p = 0.23），但高血压与手术持续时间分别存在正相关（比值比3.428 [1.436 - 8.184]，p = 0.006）和（比值比1.01 [1 - 1.019]，p = 0.046）。
SD和ND出院方式下左心房消融的并发症和再入院率相似。无论出院策略如何，高血压和手术持续时间与并发症发生率增加相关。这些数据代表了出院策略的首次并列比较，表明同日出院对于左心房消融手术是安全可行的。
