title: Early discharge compared with ordinary discharge after percutaneous coronary intervention - a systematic review and meta-analysis of safety and cost.
abstract: OBJECTIVE
  We aimed to summarize the pooled effect of early discharge compared with ordinary discharge after percutaneous coronary intervention (PCI) on the composite endpoint of re-infarction, revascularization, stroke, death, and incidence of rehospitalization. We also aimed to compare costs for the two strategies.
  
  
  METHODS
  The study was a systematic review and a meta-analysis of 12 randomized controlled trials including 2962 patients, followed by trial sequential analysis. An estimation of cost was considered. Follow-up time was 30 days.
  
  
  RESULTS
  For early discharge, pooled effect for the composite endpoint was relative risk of efficacy (RRe)=0.65, 95% confidence interval (CI) (0.52-0.81). Rehospitalization had a pooled effect of RRe=1.10, 95% CI (0.88-1.38). Early discharge had an increasing risk of rehospitalization with increasing frequency of hypertension for all populations, except those with stable angina, where a decreasing risk was noted. Advancing age gave increased risk of revascularization. Early discharge had a cost reduction of 655 Euros per patient compared with ordinary discharge.
  
  
  CONCLUSIONS
  The pooled effect supports the safe use of early discharge after PCI in the treatment of a heterogeneous population of patients with coronary artery disease. There was an increased risk of rehospitalization for all subpopulations, except patients with stable angina. Clinical trials with homogeneous populations of acute coronary syndrome are needed to be conclusive on this issue.
authors.affiliation: Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway; Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Michael
authors.initials: M
authors.lastname: Abdelnoor
authors.affiliation: Clinic of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway; Department of Health Management and Health Economics, Faculty of Medicine, University of Oslo, Oslo, Norway.
authors.forename: Jack Gunnar
authors.initials: JG
authors.lastname: Andersen
authors.affiliation: Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo Norway.
authors.forename: Harald
authors.initials: H
authors.lastname: Arnesen
authors.affiliation: Department of Cardiology, Oslo University Hospital, Oslo, Norway.
authors.forename: Odd
authors.initials: O
authors.lastname: Johansen
mesh_terms: D000368:Aged; D003362:Cost-Benefit Analysis; D005260:Female; D017721:Hospital Costs; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000191:economics* / Q000401:mortality / Q000628:therapy*; D010351:Patient Discharge / Q000191:economics*; D010359:Patient Readmission / Q000191:economics; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000191:economics* / Q000401:mortality; D017064:Process Assessment, Health Care / Q000191:economics*; D016032:Randomized Controlled Trials as Topic; D019233:Retreatment / Q000191:economics; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: cost; early discharge; meta-analysis; percutaneous coronary intervention