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27-10-2010 | Cardiology | Article

Same day discharge after low-risk PCI could halve medical costs

Abstract

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MedWire News: Canadian researchers suggest that same-day patient discharge after uncomplicated transradial percutaneous coronary intervention (PCI) and a single bolus dose of abciximab could reduce typical procedural costs by 50%.

In the Journal of the American College of Cardiology: Cardiovascular Interventions, Stéphane Rinfret (Laval University, Quebec City, Quebec, Canada) and team report a mean 30-day post-PCI saving of 1141 Canadian dollars (€804) per patient discharged on the same day as PCI compared with after an overnight stay.

This, they say "was due mainly to the reduction in cost related to the extra night for post-PCI overnight stay, as there were no significant differences in follow-up costs for procedures, physician services, or medications."

They add: "Few post-intervention strategies in health care actually save costs. Hence, our findings have important implications, both from the institution and the health care system perspective."

Rinfret and colleagues randomly assigned 1005 patients who had undergone transradial PCI and received a bolus dose of abciximab 0.25 mg/kg, to same-day home discharge with no further abciximab administration (n=504) or overnight hospital stay with a 12-hour abciximab infusion 0.125 µg/kg/minute to a maximum dose of 10 µg/min (n=501).

The team assessed the use of health care resources per patient, and the primary outcome of combined death, myocardial infarction (MI), urgent revascularization, major bleeding, repeat hospitalization, access site complication, and severe thrombocytopenia 30 days after PCI.

The findings showed that patients who had a same-day discharge stayed in hospital for 17.6 fewer hours than those discharged after an overnight stay, at 8.9 versus 26.5 hours (p<0.001).

In addition, 30-day medical costs per patient were a mean of 1141 Canadian dollars (€804) lower among same-day discharge patients than among those who stayed overnight, with 30-day expenses of 1117 versus 2258 Canadian dollars (€787 vs €1591, p<0.001).

Rinfret and team found that for same-day and overnight stay patients, a respective 80% and 89% of the total 30-day costs arose from the initial hospital stay.

No significant difference in primary outcome or follow-up costs for procedures, physician services, or medications was noted between both groups.

Repeat revascularization procedures, however, were required by five patients in the same-day discharge group compared with no patients in the overnight stay group (p=0.025).

In an accompanying editorial Andra Popescu and William Weintraub from Christiana Care Hospital in Newark, Delaware, USA warned that "these findings, although extremely enticing, must be considered critically."

Given the Canadian population used in the study, Popescu and Weintraub advised that "a US study using transradial approach ought to be available before making major changes in standard of care by discharging low-risk patients on the same day after PCI."

MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Lauretta Ihonor

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