Hanna George, Macdonald Derek, Bittira Bindu, Horlick Eric, Ali Noman, Atoui Rony, Alqahtani Abdulrahman, Fam Neil, Shurrab Mohammed, Spadafore Joanne, Allen Julie, Cheema Asim, Nalla Bhanu, Pulkkinen Carly, Cote Sylvain, Hennessey Hooman, Stringer Melissa, Leblanc Suzanne, Collin Joanne, Fenton John, Rheault-Henry Mathieu, Lauck Sandra, Sathananthan Janarthanan, Wood David, Alnasser Sami
Department of Cardiology, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Division of Cardiac Surgery, Health Sciences North, Sudbury, Ontario, Canada.
CJC Open. 2022 Aug 13;4(12):1053-1059. doi: 10.1016/j.cjco.2022.08.005. eCollection 2022 Dec.
Early hospital ( < 48 hours) discharge following transcatheter aortic valve implantation (TAVI) is an increasingly adopted practice; however, data on the safety of such an approach among patients residing in North Ontario, including remote and medically underserved areas, are lacking.
This retrospective study included patients who underwent TAVI in Sudbury, Ontario. The safety of early discharge after implementation of the Vancouver 3M (multidisciplinary, multimodality, but minimalist) clinical pathway was assessed. The primary endpoint was 30-day mortality. Resource utilization before vs after 3M clinical pathway implementation was also compared.
A total of 291 patients who underwent TAVI between 2012 and 2021 were included in the study. One in-hospital death (0.6%) occurred after the 3M clinical pathway implementation, with no mortality observed beyond hospital discharge. Eleven patients (6.7%) required rehospitalization within 30 days. The need for mechanical ventilation and surgical vascular cut-down declined from 100% and 97%, respectively, at baseline, to 6% and 2%. The number of patients receiving TAVI on a given procedural day increased from 2 to 3 patients. The median post-TAVI hospital length of stay decreased from 5 days (2-6 days) to 1 day (1-3 days) after 3M clinical pathway implementation.
Following TAVI, early discharge of selected patients residing in Northern Ontario, including rural areas, using the Vancouver 3M clinical pathway was associated with favourable outcomes, short length of stay, and more-efficient resource utilization. These data can help improve healthcare efficiency and bridge variations in TAVI funding and accessibility in underserved locations.
经导管主动脉瓣植入术（TAVI）后早期（<48小时）出院的做法越来越普遍；然而，在安大略省北部，包括偏远和医疗服务不足地区的患者中，关于这种方法安全性的数据尚缺。
这项回顾性研究纳入了在安大略省萨德伯里接受TAVI的患者。评估了实施温哥华3M（多学科、多模式但极简主义）临床路径后早期出院的安全性。主要终点是30天死亡率。还比较了3M临床路径实施前后的资源利用情况。
2012年至2021年间接受TAVI的291名患者纳入了研究。3M临床路径实施后发生了1例院内死亡（0.6%），出院后未观察到死亡情况。11名患者（6.7%）在30天内需要再次住院。机械通气和外科血管切开的需求分别从基线时的100%和97%降至6%和2%。在给定手术日接受TAVI的患者数量从2例增加到3例。3M临床路径实施后，TAVI后住院时间中位数从5天（2 - 6天）降至1天（1 - 3天）。
TAVI后，使用温哥华3M临床路径对安大略省北部包括农村地区的特定患者进行早期出院，与良好的结果、较短的住院时间和更高效的资源利用相关。这些数据有助于提高医疗效率，并弥合服务不足地区TAVI资金和可及性的差异。
