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Safety of outpatient cardiac catheterization
Insights
Outpatient cardiac catheterization is safe and cost-effective. This study found similar complication rates for inpatient and outpatient procedures, even for high-risk patients, with significant cost savings for outpatient care.
Area of Science:
- Cardiology
- Interventional Cardiology
- Health Economics
Background:
- Cardiac catheterization is a common diagnostic procedure.
- Assessing the safety and cost-effectiveness of outpatient versus inpatient settings is crucial for healthcare optimization.
Purpose of the Study:
- To compare procedure-related complications between inpatient and outpatient cardiac catheterization.
- To evaluate the safety of outpatient cardiac catheterization in high-risk patient subgroups.
- To determine the cost implications of outpatient versus inpatient cardiac catheterization.
Main Methods:
- A comparative study of inpatient (1,106 patients) and outpatient (676 patients) cardiac catheterizations performed at a single institution.
- Data collection focused on procedure-related complications (major and minor) and patient demographics.
- Analysis included subgroup analysis for high-risk patients and hospital cost comparison.
Main Results:
- Overall complication rates were statistically similar between inpatient and outpatient groups (major: 0.4% vs 0%; minor: 1.4% vs 1%).
- Outpatient cardiac catheterization demonstrated safety in high-risk subgroups, including those with left main or triple-vessel coronary disease, low ejection fraction, or recent myocardial infarction.
- Outpatient procedures resulted in 26% lower hospital-related costs compared to inpatient procedures.
Conclusions:
- Outpatient cardiac catheterization, particularly using the brachial cutdown approach, is a safe alternative to inpatient procedures, even for higher-risk patients.
- The findings support the expanded use of outpatient cardiac catheterization to improve healthcare efficiency and reduce costs.
Abstract:
In this study, we compared the procedure-related complications of inpatient and outpatient cardiac catheterization when performed at the same institution by the same group of cardiologists. The majority of the studies were done using a brachial arterial cutdown approach. The mean age, sex, cardiac diagnosis, mean left ventricular ejection fraction, and the distribution of coronary arterial lesions were similar in both groups. There were relatively more patients in the New York Heart Association's class 4 in the inpatient group (p less than 0.01). In the outpatient group (676 patients), there were no major complications, and the rate of minor complications was 1 percent. In the inpatient group (1,106 patients), the rate of major complications was 0.4 percent and of minor complications 1.4 percent. The rates of major, minor, and total complications were statistically similar between the two groups. In the outpatient group the presence of left main coronary arterial disease, triple-vessel coronary disease, a left ventricular ejection fraction less than 30 percent, or a history of a recent myocardial infarction did not alter rates of complications. The hospital-related cost of the procedure on an outpatient basis was 26 percent less than on an inpatient basis. Our findings indicate that outpatient cardiac catheterization, using a brachial cutdown approach, is safe even in a higher risk subgroup of patients and provides significant financial savings.