A PROSPECTIVE RANDOMIZED TRIAL OF OUTPATIENT VERSUS INPATIENT CARDIAC-CATHETERIZATION
A PROSPECTIVE RANDOMIZED TRIAL OF OUTPATIENT VERSUS INPATIENT CARDIAC-CATHETERIZATION
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DOI：
10.1056/nejm198811103191904
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发表时间：
1988-11-10
影响因子：
158.5
通讯作者：
COLTON, T
中科院分区：
文献类型：
--
作者：
BLOCK, PC;OCKENE, I;COLTON, T
为了评估门诊心导管置入术的安全性和成本，我们在三家医院进行了一项随机试验，将门诊（n = 192）与住院（n = 189）低危患者心导管置入术进行了比较。与住院患者相比，门诊患者的并发症发生率如下：血肿，12%对8.5%；四肢麻木或无力，0.5%对1.6%；四肢发冷或发蓝，分别为1.6%和1.1%；急性心肌梗塞，1.6%对0.5%。这些差异都没有统计学意义。两组均未发生死亡或中风。门诊组23例（12%）患者因导尿并发症需要住院治疗。在门诊组，血肿的相对危险度为1.42(95%可信区间，0.77 ~ 2.29)，一周内心肌梗死的相对危险度为2.95（95%可信区间，0.3 ~ 28.1）。两组患者在术后一周内恢复正常活动或再住院率方面无显著差异。门诊患者每位患者导管相关的总费用降低了679美元，每位患者住院总费用（包括后续治疗程序的费用）节省了885美元。我们的结论是，选择性心导管插入术作为一种门诊手术选择的病人是可行的和安全的。然而，考虑到我们的样本量小，我们敦促在解释这些发现时要谨慎，因为它们不排除门诊心导管插入术并发症发生率的小幅增加。
To evaluatethe safety and cost of outpatient cardiac catheterization, we conducted a randomized trial at three hospitals of outpatient (n = 192) as compared with inpatient (n = 189) cardiac catheterization in low-risk patients. Outpatients had the following complication rates as compared with inpatients: hematoma, 12 versus 8.5 percent; numbness or weakness of extremity, 0.5 versus 1.6 precent; cold or blue extremity, 1.6 versus 1.1 percent; and acute myocardial infarction, 1.6 versus 0.5 percent. None of these differences were statistically significant. No deaths or strokes occurred in either group. Twenty-three patients (12 percent) assigned to the outpatient group required hospitalization because of complications of catheterization. In the outpatient group, the relative risk for hematoma was 1.42 (95 percent confidence interval, 0.77 to 2.29), and the relative risk for myocardial infarction with in one week was 2.95 (95 percent confidence interval, 0.3 to 28.1). There were not significant differences between the two groups in whether they resume normal activities or in the rates of rehospitalization within one week of the procedure. Total catheterization-related charges per patient were $679 lower for outpatients, with a savings in total hospital charges (including charges for subsequent therapeutic procedures) of $885 per patient. We conclude that elective cardiac catheterization as an outpatient procedure for selected patients is feasible and safe. Given the small size our sample, however, we urge caution in interpreting these findings, since they do not exclude a small increase in complication rates with outpatient cardiac catheterization.