title: Prevalence and outcomes of same-day discharge after elective percutaneous coronary intervention among older patients.
abstract: BACKGROUND
  Patients undergoing elective percutaneous coronary intervention (PCI) are generally observed overnight in the hospital. The association between same-day discharge of older patients and death or readmission is unclear.
  
  
  OBJECTIVE
  To evaluate the prevalence and outcomes of same-day discharge among older patients undergoing elective PCI in the United States.
  
  
  METHODS
  Multicenter cohort study. Data were from 107,018 patients 65 years or older undergoing elective PCI procedures at 903 sites participating in the CathPCI Registry between November 2004 and December 2008 and were linked with Medicare Part A claims. Patients were divided into 2 groups based on their length of stay after PCI: same-day discharge or overnight stay.
  
  
  METHODS
  Death or rehospitalization occurring within 2 days and by 30 days after PCI.
  
  
  RESULTS
  The prevalence of same-day discharge was 1.25% (95% CI, 1.19%-1.32%; n = 1339 patients) with significant variation across facilities. Patient characteristics were similar between the 2 groups, although same-day discharge patients underwent shorter procedures with less multivessel intervention. There were no significant differences in the rates of death or rehospitalization at 2 days (same-day discharge, 0.37% [95% CI, 0.16%-0.87%] vs overnight stay, 0.50% [95% CI, 0.46%-0.54%]; P = .51) or at 30 days (same-day discharge, 9.63% [95% CI, 8.17%-11.33%] vs overnight stay, 9.70% [95% CI, 9.52%-9.88%]; P = .94). Among patients with adverse outcomes, the median time to death or rehospitalization did not differ significantly between the groups (same-day discharge, 13 days [interquartile range, 7.0-21.0] vs overnight stay, 14 days [interquartile range, 7.0-21.0]; P = .96). After adjustment for patient and procedure characteristics, same-day discharge was not significantly associated with 30-day death or rehospitalization (adjusted odds ratio, 0.95 [95% CI, 0.78-1.16]).
  
  
  CONCLUSIONS
  Among selected low-risk Medicare patients undergoing elective PCI, same-day discharge is rarely implemented but is not associated with death or rehospitalization compared with overnight observation.
authors.affiliation: Duke Clinical Research Institute, 508 Fulton St, Durham, North Carolina, USA. sunil.rao@duke.edu
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Kaltenbach
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.forename: Ralph G
authors.initials: RG
authors.lastname: Brindis
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
mesh_terms: D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D018579:Patient Selection; D015995:Prevalence; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States