{"id":12278,"date":"2011-10-04T16:08:01","date_gmt":"2011-10-04T20:08:01","guid":{"rendered":"http:\/\/blogs.nejm.org\/cardioexchange\/?post_type=interventional&#038;p=12278"},"modified":"2011-10-04T16:08:01","modified_gmt":"2011-10-04T20:08:01","slug":"is-%e2%80%9cstent-and-send%e2%80%9d-safe-for-older-patients","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/cardioexchange\/2011\/10\/04\/is-%e2%80%9cstent-and-send%e2%80%9d-safe-for-older-patients\/","title":{"rendered":"Is \u201cStent and Send\u201d Safe for Older Patients?"},"content":{"rendered":"<p><strong><em>Should older patients who\u00a0undergo elective coronary artery stenting be sent home the same day? <\/em><\/strong><\/p>\n<p>Using data from the <a href=\"https:\/\/www.ncdr.com\/webncdr\/DefaultCathPCI.aspx\">CathPCI Registry<\/a>, <a href=\"http:\/\/jama.ama-assn.org\/content\/306\/13\/1461.abstract\">Rao and colleagues <\/a>examined outcomes\u00a0in Medicare-eligible\u00a0patients who underwent elective, first-time PCI.\u00a0The investigators\u00a0identified 107,018 patients (&lt;11% of the million-plus older patients undergoing PCI\u00a0during 2005\u20132008 after exclusion of\u00a0those with ACS or\u00a0shock and those\u00a0transferred from another hospital or undergoing an urgent, emergent, or salvage procedure) and compared patients who\u00a0were discharged the\u00a0same day\u00a0with those who were observed in the hospital\u00a0overnight (see <a href=\"http:\/\/blogs.nejm.org\/cardioexchange\/news\/same-day-discharge-after-pci-safe-but-rarely-used\/\">CardioExchange News blog<\/a>).<\/p>\n<p><strong><em>What did the study authors\u00a0find?<\/em><\/strong><\/p>\n<p>1.\u00a0 Only 1.3% of older patients undergoing elective PCI were discharged the same day of the procedure.<\/p>\n<p>2. Compared with overnight observation, <strong><em>same-day discharge was not associated with an increased risk\u00a0for death or readmission,\u00a0either\u00a0within 2 days\u00a0or at 30 days after discharge.<\/em><\/strong><\/p>\n<p><strong><em>Were the same\u2013day-discharge and overnight-observation patients similar? <\/em><\/strong><\/p>\n<p>Not really. Compared\u00a0with the overnight-observation patients, those discharged on the same day were more likely to have vascular closure devices and less likely to have received glycoprotein IIb\/IIIa inhibitors, bivalirudin,\u00a0or multivessel PCI.<\/p>\n<p><strong><em>The authors\u00a0conclude that \u201cselected low-risk patients may be considered for same-day discharge.\u201d <\/em><\/strong><\/p>\n<p><strong>What do you think?<\/strong><\/p>\n<p><em>Do their observational data support their conclusion?<\/em><\/p>\n<p><em>What percentage of patients 65 years or older in your practice are low-risk and eligible for same-day discharge\u00a0after PCI?<\/em><\/p>\n<p><em>Should we be making policy decisions based on data from\u00a0the CathPCI Registry (which is a voluntary, unaudited registry)?<\/em><\/p>\n<p><em>Given that\u00a0inpatient PCI in the U.S. is reimbursed at a higher rate than outpatient PCI (in-hospital observation for 23 hours or less),\u00a0do you perceive\u00a0a financial incentive to avoid same-day discharge in favor of hospital admission?<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Should older patients who\u00a0undergo elective coronary artery stenting be sent home the same day? Using data from the CathPCI Registry, Rao and colleagues examined outcomes\u00a0in Medicare-eligible\u00a0patients who underwent elective, first-time PCI.\u00a0The investigators\u00a0identified 107,018 patients (&lt;11% of the million-plus older patients undergoing PCI\u00a0during 2005\u20132008 after exclusion of\u00a0those with ACS or\u00a0shock and those\u00a0transferred from another hospital or [&hellip;]<\/p>\n","protected":false},"author":214,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1,9],"tags":[1006,372,984,1007],"class_list":["post-12278","post","type-post","status-publish","format-standard","hentry","category-general","category-interventional-cardiology","tag-cathpci-registry","tag-elective-pci","tag-hospital-procedures","tag-outpatient-procedures"],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/12278","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/users\/214"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/comments?post=12278"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/posts\/12278\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/media?parent=12278"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/categories?post=12278"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/cardioexchange\/wp-json\/wp\/v2\/tags?post=12278"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}