Key result
Same-day discharge after left atrial appendage occlusion showed no significant difference in readmission (RR 0.61; 95% CI 0.29-1.31) but lower major bleeding or vascular complications (RR 0.71).
Why the study?
Most patients undergoing LAAO are admitted overnight, but whether a same-day discharge strategy can improve resource utilization without compromising safety is unclear.
Does same-day discharge improve safety outcomes compared to hospital admission in patients undergoing LAAO procedure?
Meta-Analysis
Does same-day discharge improve safety outcomes compared to hospital admission in patients undergoing LAAO procedure?
Relative Risk: 0.61 (95% CI 0.29–1.31)
p-value: p=0.21
Same-day discharge after LAAO appears safe with no significant increase in readmissions, stroke, or mortality, and is associated with lower bleeding and vascular complications compared to overnight admission.
Supports same-day discharge after LAAO as safe; extends evidence by associating it with fewer bleeding and vascular complications.
INTRODUCTION: Most patients undergoing a left atrial appendage occlusion (LAAO) procedure are admitted for overnight observation. A same-day discharge strategy offers the opportunity to improve resource utilization without compromising patient safety. We compared the patient safety outcomes and post-discharge complications between same-day discharge versus hospital admission (HA) (>1 day) in patients undergoing LAAO procedure. METHODS: A systematic search of MEDLINE and Embase was conducted. Outcomes of interest included peri-procedural complications, re-admissions, discharge complications including major bleeding and vascular complications, ischemic stroke, all-cause mortality, and peri-device leak >5 mm. Mantel-Haenszel risk ratios (RRs) with 95% CIs were calculated. RESULTS: A total of seven observational studies met the inclusion criteria. There was no statistically significant difference between same-day discharge versus HA regarding readmission (RR: 0.61; 95% confidence interval [CI]: [0.29-1.31]; p = .21), ischemic stroke after discharge (RR: 1.16; 95% CI: [0.49-2.73]), peri-device leak >5 mm (RR: 1.27; 95% CI: [0.42-3.85], and all-cause mortality (RR: 0.60; 95% CI: [0.36-1.02]). The same-day discharge study group had significantly lower major bleeding or vascular complications (RR: 0.71; 95% CI: [0.54-0.94]). CONCLUSIONS: This meta-analysis of seven observational studies showed no significant difference in patient safety outcomes and post-discharge complications between same-day discharge versus HA. These findings provide a solid basis to perform a randomized control trial to eliminate any potential confounders.
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Khan et al. (2023) conducted a meta-analysis in Left atrial appendage occlusion (LAAO). Same-day discharge vs. Hospital admission (>1 day) was evaluated on Readmission (RR 0.61, 95% CI 0.29-1.31, p=0.21). Same-day discharge after left atrial appendage occlusion showed no significant difference in readmission (RR 0.61; 95% CI 0.29-1.31) but lower major bleeding or vascular complications (RR 0.71).
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