Trends in Use and Outcomes of Same-Day Discharge Following Elective Percutaneous Coronary Intervention.
Trends in Use and Outcomes of Same-Day Discharge Following Elective Percutaneous Coronary Intervention.
复制标题
选择性经皮冠状动脉介入治疗后当天出院的使用趋势和结果。
DOI：
10.1016/j.jcin.2021.05.043
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发表时间：
2021
期刊：
影响因子：
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通讯作者：
Rao,SunilV
中科院分区：
文献类型：
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作者：
Bradley,StevenM;Kaltenbach,LisaA;Xiang,Katelyn;Amin,AmitP;Hess,PaulL;Maddox,ThomasM;Poulose,Anil;Brilakis,EmmanouilS;Sorajja,Paul;Ho,PMichael;Rao,SunilV
本研究的目的是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变化，并评估当天出院趋势与患者结局之间的关系。从2009年7月1日至2017年12月31日，国家心血管数据登记中心CathPCI登记中心的716家医院，评估了当天出院的总体和医院水平趋势。在212，369名患者中，谁链接到医疗保险和医疗补助服务中心的数据，同一天出院和30天死亡率和再住院之间的关联进行了assessed.ResultsA共114，461例（14.0%）出院的同一天PCI。当天出院的患者比例从2009年第三季度的4.5%上升至2017年第四季度的28.6%。从2009年到2017年，股动脉PCI的当天出院率从4.3%增加到19.5%，桡动脉PCI的当天出院率从9.9%增加到39.7%。使用当天出院的医院水平差异始终存在（按年份和桡动脉入路调整的中位比值比：4.15）。风险调整后的30天死亡率不随时间变化，而风险调整后的再住院率随时间下降，且当天出院更快（P <0.001）。同一天出院的医院水平变化可能代表了在不影响患者结局的情况下降低成本的机会。
ObjectivesThe 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.BackgroundInsights on contemporary use of same-day discharge following elective PCI are limited.MethodsIn 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.ResultsA 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 (Pfor interaction <0.001).ConclusionsIn 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.