Same-day discharge among patients undergoing elective PCI: Insights from the VA CART Program

Area of Science:

• Cardiovascular Medicine
• Health Services Research
• Interventional Cardiology

Background:

• Same-day discharge (SDD) after elective percutaneous coronary intervention (PCI) is considered safe for select patients.
• Limited data exist on the adoption, safety, and cost-effectiveness of SDD in universal healthcare systems, such as the Veterans Affairs (VA) Health System.

Purpose of the Study:

• To evaluate the contemporary adoption rates, safety, and costs associated with SDD for elective PCI within the VA Health System.
• To compare 30-day outcomes (readmission, mortality) and costs for patients discharged on the same day versus those with an overnight stay after elective PCI.

Main Methods:

• Utilized data from the VA Clinical Assessment Reporting and Tracking (CART) Program linked with Health Economics Resource Center data.
• Included patients undergoing elective PCI for stable angina between October 2007 and September 2016.
• Employed 2:1 propensity matching to compare SDD versus overnight stay groups on 30-day readmission, mortality, and total costs.

Main Results:

• SDD adoption increased from 1.6% in 2008 to 9.7% in 2016, with 3.9% of 21,261 PCIs being SDDs.
• SDD patients had lower rates of comorbidities and were treated at higher-volume centers.
• No significant differences in 30-day readmission (6.7% vs. 5.6%) or mortality (0% vs. 0.07%) were observed between SDD and overnight stay groups.
• SDD was associated with median cost savings of $1503 per patient.

Conclusions:

• The VA Health System has increasingly adopted SDD for elective PCI, demonstrating its safety and cost-saving potential.
• Increased adoption of SDD can lead to significant cost reductions without adversely affecting patient outcomes.
• SDD represents a viable strategy for optimizing resource utilization in elective PCI within the VA system.