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Same-day discharge after elective percutaneous coronary intervention (PCI) appeared underutilized in the U.S. in data covering 2006-2015, despite its proven safety and cost savings, a study found.

A 9.1% unadjusted rate of same-day discharge became just 3.5% after accounting for significant interhospital variation, according to the pool of eligible patients recorded in the Premier Healthcare Database as having undergone elective PCI (n=672,470) during the 10-year period.

Adoption of same-day discharge grew from 0.4% in 2006 to 6.3% in 2015, but the U.S. healthcare system can do better, argued researchers led by Amit Amin, MD, MSc, of Washington University School of Medicine in St. Louis, from their study published online in .

The 493 hospitals included in the analysis varied in same-day discharge rates ranging from 0% to 83%. A median 382% higher likelihood of this practice at one hospital than at another indicated that "SDD [same-day discharge] practices in the United States are essentially random and likely driven by the local culture rather than evidence-based practices," Amin's group said.

They found that patients discharged the day of their PCI were at no higher risk of death, bleeding, acute kidney injury, or acute MI over 1 year -- in line with several randomized clinical trials that have confirmed the safety of same-day discharge.

Moreover, same-day discharge was associated with $5,128 saved per procedure, driven by savings in supply and room and board costs.

If the top 10% of hospitals by same-day discharge (median 44.5%) were to be matched by the rest of U.S. centers (median 2.2%), the U.S. healthcare system would have saved $129 million per year in the study sample alone -- or $577 million annually across the country, according to the investigators.

The hospitals that tended to have same-day discharge rates exceeding 20% were the ones with fewer than 100 beds and ones that used more transradial access in PCI.

Where there was more use of low-molecular-weight heparin and glycoprotein IIb/IIIa, the same-day discharge rate was usually less than 5%, as were hospitals with 100-199 beds.

"Our study and prior studies indicate that while SDD is increasing perhaps because of a greater adoption of radial access, SDD is still performed only in few patients undergoing elective PCI, and the magnitude of the increase has been modest and the room for improvement is substantial," Amin and colleagues emphasized.

A "patient-centered" protocol for same-day discharge, based on a patient's risks of complications, led to one center quickly getting 70% of its elective PCI patients discharged the same day, according to a previous study from this group. This experience was tied to $1.8 million in cost savings per year.

The cross-sectional cohort study by Amin's group included a population that was 33.0% women and 73.1% white.

Limitations included potential for residual confounding and misclassified outcomes. Additionally, the dataset used only went up to 2015 and may therefore be outdated.

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