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A prospective randomized trial of outpatient versus inpatient cardiac catheterization
P C Block1, I Ockene, R J Goldberg
1Massachusetts General Hospital, Cardiac Unit, Boston 02114.
Insights
Outpatient cardiac catheterization is safe and cost-effective for selected low-risk patients, with similar complication rates to inpatient procedures. This approach offers significant cost savings without compromising patient outcomes or recovery time.
Area of Science:
- Cardiology
- Health Economics
Background:
- Cardiac catheterization is a common diagnostic and therapeutic procedure.
- Traditionally performed as an inpatient procedure, its suitability for outpatient settings is under investigation.
Purpose of the Study:
- To evaluate the safety and cost-effectiveness of outpatient versus inpatient cardiac catheterization in low-risk patients.
Main Methods:
- A randomized trial comparing outpatient (n=192) and inpatient (n=189) cardiac catheterization in low-risk patients across three hospitals.
- Complication rates, need for hospitalization, resumption of activities, rehospitalization rates, and total charges were analyzed.
Main Results:
- No statistically significant differences in complication rates (hematoma, extremity issues, myocardial infarction) between outpatient and inpatient groups.
- 12% of outpatients required hospitalization; no deaths or strokes occurred in either group.
- Outpatient cardiac catheterization resulted in significant cost savings of $679-$885 per patient.
Conclusions:
- Elective cardiac catheterization as an outpatient procedure is feasible and safe for selected patients.
- While findings suggest safety and cost benefits, caution is advised due to the small sample size.
- Further research may be needed to definitively exclude a small increase in complication rates with outpatient procedures.
Abstract:
To evaluate the 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 percent; 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 within one week was 2.95 (95 percent confidence interval, 0.3 to 28.1). There were no significant differences between the two groups in whether they resumed 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 of 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.