Association of Same-Day Discharge After Elective Percutaneous Coronary Intervention in the United States with Costs and Outcomes
November 18, 2019
THE HEALTH ECONOMIES QUESTION STUDIED
Same-day discharge (SDD) after elective percutaneous coronary intervention (PCI) is associated with lower costs and preferred by patients, although patterns of discharge in the US are unknown following the procedure. This study investigated the incidence and trends in SDD, hospital variations, the association between SDD and readmissions for bleeding, acute kidney injury (AKI), acute myocardial infarction (AMI), or mortality at 30, 90, and 365 days after PCI, and hospital costs of SDD and its drivers.
Observational cross-sectional cohort study on 672,470 patients enrolled in a national administrative claims healthcare database (Premier Healthcare) who underwent elective PCI at 493 hospitals between Jan 2006 and Dec 2015 with 1-year follow-up. This database represents approximately 20% of all acute care hospitalizations in the US for more than 15 years.
The unadjusted, overall SDD rate of (9.1%) was corrected to an adjusted overall rate of 3.5% (95% CI, 3.0%-4.0%), which increased from 0.4% in 2006 to 6.3% in 2015. Thus, SDD after elective PCI was infrequent; substantial hospital variation for SDD was seen from 0% to 83%. 1 in 5 elective radial PCI patients underwent SDD. There was no higher risk of death, bleeding, AKI, or AMI at 30, 90, or 365 days for SDD vs non-SDD. SDD was associated with a cost savings of $5128 per procedure, driven mainly by reduced costs of room and boarding and central supplies. Changes in present SDD practices in the US could have saved $129 million annually in this population.
Temporal Trends and Hospital Variation in the Practice of Same-Day Discharge (SDD).
Cost Savings Associated With SDD and Drivers of Cost Savings
HEALTH ECONOMICS IMPLICATIONS
SDD was safe in the short and long term. Cost savings of more than $5000 per PCI are associated with SDD. Greater and more consistent use of SDD could save US hospitals about $577 million if adopted in the entire country. More consistent use of SDD could markedly increase the overall value of PCI care
About the Author
Sr. Strategic Business Account Manager
Terumo Health Outcomes
As Strategic Business Account Manager, John assists hospitals in understanding the full financial impact of their care pathway redesign and their ROI. John earned a Master’s Degree in Business from Montclair State University, and has spent over 15 years in the health care fields of cardiology, electrophysiology, orthopedics, and diagnostic imaging. He has worked closely with hospital leadership to develop programs focused on the economic costs of healthcare procedures, including initiating radial adoption, creating reprocessing initiatives and establishing value-based contracts.