Defining the length of stay following percutaneous coronary intervention

Abstract

Percutaneous coronary intervention (PCI) is the most common method of coronary revascularization. Over time, as operator skills and technical advances have improved procedural outcomes, the length of stay (LOS) has decreased. However, standardization in the definition of LOS following PCI has been challenging due to significant physician, procedural, and patient variables. Given the increased focus on both patient safety as well as the cost of medical care, system process issues are a concern and provide a driving force for standardization while simultaneously maintaining the quality of patient care. This document:(1) provides a summary of the existing published data on same-day patient discharge following PCI, (2) reviews studies that developed methods to predict risk following PCI, and (3) provides clarification of the terms used to define care settings following PCI. In addition, a decision matrix is proposed for the care of patients following PCI. It is intended to provide both the interventional cardiologist as well as the facilities, in which they are associated, a guide to allow for the appropriate LOS for the appropriate patient who could be considered for early discharge or outpatient intervention. V C 2009 Wiley-Liss, Inc.

Novel Patient‐Centered Approach to Facilitate Same‐Day Discharge in Patients Undergoing Elective Percutaneous Coronary Intervention

“…Unfortunately, the existing SDD “criteria,”17 which are applicable to a lower‐risk population, are potentially too conservative to be applied in an increasingly complex elective PCI population treated in contemporary practice. As elective PCI complexity and patient comorbidity further increase, a risk‐based approach is likely to be the best strategy for safely guiding SDD decisions.…”

“…To estimate the adjusted cost associated with SDD, we used the total costs as the dependent variable and SDD (coded as 1 or 0) and quintiles of the logarithm‐odds propensity score as the covariates in a least‐squares linear regression model. Finally, we applied the SDD criteria recommended in the 2009 SCAI expert consensus statement17 to our “patient‐centered” SDD population, to examine the proportion of patients not meeting SCAI criteria for SDD.…”

Prediction of Length of Stay Following Elective Percutaneous Coronary Intervention

“…Therefore, the tree-structured prognostic classification model will aid the practitioner, early on, in the decision process regarding the need for extended observation after PCI. This early on assessment should be augmented by the individual patient's specific condition after the procedure, as recommended by a recent consensus panel [19]. …”

“…Also important are other postprocedural outcomes such as length of stay (LOS). LOS in particular is an index of patient safety and is a driver of health care expenditure [19]. LOS is likely to be influenced by both patient presenting features and procedural complications; therefore, it is logical to assess the performance of postprocedural risk classification models with respect to LOS.…”

Incidence and Predictors of 30-Day Hospital Readmission Rate Following Percutaneous Coronary Intervention (from the National Heart, Lung, and Blood Institute Dynamic Registry)

“…Hospital length of stay (LOS) and in-hospital mortality following percutaneous coronary intervention (PCI) represent acute process and quality of care measures, respectively (1,2). Important and complementary measures of overall PCI quality are those that occur after hospital discharge (1,3).…”