title: Trends and predictors of length of stay after primary percutaneous coronary intervention: a report from the CathPCI registry.
abstract: BACKGROUND
  Post hoc analyses of clinical trials suggest that certain patients are eligible for early discharge after ST-segment elevation myocardial infarction. The extent to which ST-segment elevation myocardial infarction patients are discharged early after primary percutaneous coronary intervention (PPCI) in current practice is unknown.
  
  
  METHODS
  We examined 115,113 patients in the CathPCI Registry to assess temporal trends in length of stay (LOS) after PPCI. Baseline characteristics were compared between patients with LOS ≤2 and >2 days. Predictors of LOS >2 days were determined by logistic regression and adjusted for clustering among centers. Patterns of discharge within 2 days for low-risk patients with no inhospital complications were examined.
  
  
  RESULTS
  From January 2005 through March 2009, mean LOS (4.0 ± 3.0 to 3.6 ± 2.7 days) (P for trend <.001) and the proportion of patients discharged after 2 days decreased (72.0%-65.9%), while predicted inhospital mortality risk remained unchanged. Patients with LOS >2 days (n = 77,471; 67.3%) were older and more likely to have had an intra-aortic balloon pump, cardiogenic shock, transfusions, and post-PPCI complications. Of 958 hospitals, 437 (45.6%) discharged at least half of their low-risk patients with no inhospital complications within 2 days.
  
  
  CONCLUSIONS
  While the predicted risk profile has remained stable, there has been a significant decrease in LOS after PPCI. Nevertheless, hospitals vary in discharging low-risk and uncomplicated patients early. Discharge within 2 days was associated with specific patient, procedure, and hospital factors. Further study is needed to determine the safety of early discharge among patients undergoing PPCI.
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA. chin.chee.tang@nhcs.com.sg
authors.forename: Chee Tang
authors.initials: CT
authors.lastname: Chin
authors.forename: William S
authors.initials: WS
authors.lastname: Weintraub
authors.forename: David
authors.initials: D
authors.lastname: Dai
authors.forename: Rajendra H
authors.initials: RH
authors.lastname: Mehta
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
authors.forename: H Vernon
authors.initials: HV
authors.lastname: Anderson
authors.forename: John C
authors.initials: JC
authors.lastname: Messenger
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kutcher
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Ralph G
authors.initials: RG
authors.lastname: Brindis
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000639:trends*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D012042:Registries; D012307:Risk Factors; D013997:Time Factors; D014481:United States