Contributors to the growth of same day discharge after elective percutaneous coronary intervention

Taxiarchi, Paraskevi, Martin, Glen P., Kinnaird, Tim, Curzen, Nick, Ahmed, Javed, Ludman, Peter, De Belder, Mark, Shoaib, Ahmad, Rashid, Muhammad, Kontopantelis, Evangelos and Mamas, Mamas A. (2020) Contributors to the growth of same day discharge after elective percutaneous coronary intervention. Circulation. Cardiovascular interventions, 13 (3), [e008458]. (doi:10.1161/CIRCINTERVENTIONS.119.008458).

Abstract

BACKGROUND: Financial pressures for reducing hospitalization costs have driven to a move toward same day discharge (SDD) following uncomplicated percutaneous coronary intervention. The UK healthcare system has transitioned to predominantly SDD for elective percutaneous coronary intervention. This study aimed to examine patient's clinical, procedural, and institutional characteristics that are associated with the increased adoption of SDD adoption over time in the United Kingdom and determine whether these vary by region.

METHODS: The data were derived from the British Cardiovascular Intervention Society including all the elective percutaneous coronary intervention from 2007 to 2014 in the United Kingdom. We structured 8 meaningful groups of variables, and their relative importance was obtained by decomposing the R2 in each study year.

RESULTS: The relative importance of Strategic Health Authorities was substantially higher than all other factors every year, with some reduction over time, from 49.2% (95% CI, 45.4%-52.4%) in 2007 to 43.4% (95% CI, 39.9%-46.6%) in 2014. Center volume followed with 8.95% (95% CI, 7.0%-10.9%) to 19.8% (95% CI, 16.7%-22.4%). Between patients' clinical and procedural characteristics, pharmacology and access site had the highest relative importance values, from 14.3% (95% CI, 12.1%-16.4%) to 7.1% (95% CI, 5.5%-8.8%) and from 3.6% (95% CI, 2.3%-5.1%) to 11.8% (95% CI, 9.4%-14.3%), respectively. Relative importance of different groups varied differently across Strategic Health Authorities.

CONCLUSIONS: Growth of SDD was mainly associated with regional characteristics, while subcontributors varied substantially between different regions. Standardized guidelines would provide more homogenous adoption of SDD nationally. This analysis might be of wider interest in healthcare systems slower in SDD adoption.

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Contributors

Author: Nick Curzen

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