Key result
A same-day discharge protocol for LAAO yielded similar 45-day outcomes, a 15% reduction in total costs, and a longer mean procedure time (62.1 vs 51.1 min; P=0.01) vs conventional strategy.
Why the study?
During the COVID-19 pandemic, a same-day discharge protocol was implemented for LAAO, prompting an evaluation of its safety, feasibility, and cost-effectiveness.
Does a same-day discharge protocol reduce length of stay and costs without increasing adverse events in patients undergoing LAAO?
Cohort (n=142)
No
Does a same-day discharge protocol reduce length of stay and costs without increasing adverse events in patients undergoing LAAO?
A same-day discharge protocol for LAAO using CTA planning and ICE is safe, feasible, and reduces hospital costs and length of stay compared to conventional admission.
Supports same-day LAAO discharge to cut costs and stay; leaves open need for randomized confirmation before practice change.
BACKGROUND: Percutaneous left atrial appendage occlusion (LAAO) with the Watchman device is FDA approved for stroke prevention in patients with nonvalvular atrial fibrillation who have an appropriate indication. During the COVID-19 pandemic, a same-day discharge protocol (SDDP) was employed to improve resource utilization, relieve hospital occupation, and reduce the possible risk of in-hospital virus transmission. OBJECTIVES: We sought to analyze the safety, feasibility, and cost effectiveness for SDDP in patients receiving LAAO. METHODS: A prospective analysis of 142 consecutive patients, 119 treated prior to SDDP and 23 who underwent SDDP following LAAO with cardiac computed tomography angiography (CTA)-guided pre-procedural planning and intracardiac echocardiogram (ICE). Procedures were performed in a single, large academic hospital in the United States. In-hospital and 45-day procedural success, adverse events, length of procedure, and length-of-stay were evaluated. RESULTS: Baseline patient characteristics including mean CHA2DS2VASc scores and mean HAS-BLED scores were similar in both groups. All procedures were successful. There was no significant difference in rates of procedural complications or in-hospital adverse events. The mean procedure time in the SDDP group was 11 minutes longer than in the conventional group (62.1 ± 5.9 vs 51.1 ± 21; P=.01). Outcomes at 45-day follow-up were similar. SDDP was associated with a reduced length of stay compared with conventional strategy and a 15% reduction in total costs. CONCLUSIONS: Same-day discharge strategy for LAAO appears safe, feasible and could become the new standard approach for LAAO. A protocol including CTA pre-procedural planning, ICE-guided deployment and conscious sedation reduces hospital occupation and lowers costs.
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Dallan et al. (2022) conducted a cohort in nonvalvular atrial fibrillation (n=142). Same-day discharge protocol (SDDP) vs. Conventional strategy (prior to SDDP) was evaluated on Safety, feasibility, and cost effectiveness (including procedural success, adverse events, length of procedure, and length-of-stay). A same-day discharge protocol for LAAO yielded similar 45-day outcomes, a 15% reduction in total costs, and a longer mean procedure time (62.1 vs 51.1 min; P=0.01) vs conventional strategy.
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