Thirty-day readmission rate of same-day discharge protocol after left atrial appendage occlusion: A propensity score-matched analysis from the National Readmission Database

Heart Rhythm. 2022 Nov;19(11):1819-1825. doi: 10.1016/j.hrthm.2022.07.006. Epub 2022 Jul 11.

Abstract

Background: Given the reduction in periprocedural complication rates, same-day discharge (SDD) after percutaneous left atrial appendage closure (LAAC) could be beneficial. To date, little data exist comparing the standard overnight stay (ONS) vs SDD after LAAC.

Objective: The purpose of this study was to investigate the safety and efficacy of SDD compared with ONS.

Methods: A retrospective cohort study of LAAC procedures performed in the United States from 2015 to 2019 was conducted using the US Nationwide Readmission Database. The primary outcome was all-cause 30-day readmission after discharge in patients who underwent LAAC, and a secondary outcome was requiring total health care cost. A 1:1 propensity score matching was conducted for adjustment. Multivariate Cox proportional hazards regression was also performed to estimate the hazard ratio for all-cause readmission within 30 days of LAAC.

Results: Of 48,953 patients (mean age 76.0 ± 7.9 years), 972 patients (1.99%) were discharged on the same day after LAAC (SDD group) and the remaining 47,981 patients stayed at least 1 night (ONS group). A propensity score-matched analysis generated 961 matched pairs in each group. The 30-day readmission rate after discharge was similar between the groups (SDD vs ONS: 8.5% vs 9.8%; P = .31; hazard ratio 1.13; 95% confidence interval 0.78-1.63; P = .53). The total required health care cost was significantly lower in the SDD group ($23,720 [$18,075-$29,416] vs $25,877 [$19,906-$32,748]; P < .01). Gastrointestinal bleeding was the major cause for readmission (SDD vs ONS: 14.7% vs 15.1%; P = .95), but stroke and pericardial effusion were rare.

Conclusion: In patients without procedure-related complications, SDD is a safe and cost-effective protocol.

Keywords: Complication; Health care cost; Left atrial appendage occlusion; Readmission; Same-day discharge; Watchman.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Atrial Appendage* / surgery
  • Atrial Fibrillation* / complications
  • Atrial Fibrillation* / surgery
  • Humans
  • Patient Discharge
  • Patient Readmission
  • Propensity Score
  • Retrospective Studies
  • Stroke* / etiology
  • Treatment Outcome
  • United States / epidemiology