Singh Sheldon M, Fang Jiming, Haldenby Olivia, Ko Dennis T
Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
CJC Open. 2025 Mar 8;7(5):564-570. doi: 10.1016/j.cjco.2025.03.001. eCollection 2025 May.
Variation exists in the practice of same-day discharge (SDD) after supraventricular tachycardia (SVT) catheter-ablation procedures. The aim of this study was to evaluate factors associated with SDD after SVT catheter-ablation procedures.
All Ontario residents aged > 18 years undergoing a first-ever SVT ablation procedure between April 1, 2011 and May 31, 2020 were included. The rate of SDD at each hospital and the annual rate within Ontario were determined. A series of logistic regression models were created to determine the influence of clinical and procedural characteristics, and of the hospital performing the procedure, on the probability of SDD occurring. The median odds ratio was calculated to estimate the variation in the odds of similar patients receiving SDD at different hospitals.
The cohort included 16,044 individuals (aged 55.9 ± 16.5 years; female: 45.9%). Transseptal catheterization was performed in 7.8% of the cohort. The rate of SDD increased from 61% in 2011 to 91% in 2020. Hospital rates of SDD ranged from 41% to 95%. The discrimination ability (measured by C-statistics) in predicting SDD was high, at 0.84, in the model that included the hospital, as opposed to 0.58 in the model that did not include the hospital. After adjusting for age, sex, patient comorbidities, the arrhythmia diagnosis, and procedural details, the median odds ratio attributed to the hospital performing the procedure was 3.82.
Variation in SDD after SVT ablation procedures is primarily related to hospital factors. Policymakers are encouraged to explore hospital-level barriers to adopting this approach.
室上性心动过速（SVT）导管消融术后当日出院（SDD）的实践存在差异。本研究的目的是评估与SVT导管消融术后SDD相关的因素。
纳入2011年4月1日至2020年5月31日期间首次接受SVT消融手术的所有年龄大于18岁的安大略省居民。确定每家医院的SDD率以及安大略省内的年SDD率。建立一系列逻辑回归模型，以确定临床和手术特征以及实施手术的医院对SDD发生概率的影响。计算中位数优势比，以估计不同医院中相似患者接受SDD的优势差异。
该队列包括16044人（年龄55.9±16.5岁；女性：45.9%）。队列中有7.8%的患者进行了经房间隔导管消融术。SDD率从2011年的61%上升至2020年的91%。医院的SDD率在41%至95%之间。在包含医院的模型中，预测SDD的辨别能力（用C统计量衡量）较高，为0.84，而在不包含医院的模型中为0.58。在调整年龄、性别、患者合并症、心律失常诊断和手术细节后，实施手术的医院的中位数优势比为3.82。
SVT消融术后SDD的差异主要与医院因素有关。鼓励政策制定者探索医院层面采用这种方法的障碍。
