Same-day discharge versus overnight stay after pulmonary vein isolation: an assessment on clinical outcomes and healthcare utilization

Abstract

Background: Atrial fibrillation is increasingly prevalent and constitutes a severe economic and clinical burden. Pulmonary vein isolation (PVI) is an effective treatment. Evidence on the safety of same-day discharge (SDD) after PVI, instead of overnight stay (ONS), is limited. Methods and results: This retrospective study uses data from PVI’s performed between June 2018 and December 2020 in the Netherlands. Baseline characteristics, clinical outcome data, and healthcare utilization, extracted from two national databases, were compared between the implementation of an SDD protocol in a single center and a national benchmark where the majority is an ONS strategy. Descriptive and bivariate analyses were performed. We included data from 11,812 PVI’s,1360 in the SDD protocol group, and 10,452 for the ONS benchmark. The SDD protocol group performed 57.7% of PVI’s in SDD, while the benchmark performed 5.3% (p < 0.001). The SDD protocol group performed more cryoballoon PVI (90.8% vs. 39.2%, p < 0.001). There were no differences in bleeding (p = 0.830), thromboembolic (p = 0.893), vascular complications (p = 0.720), or cardiac tamponade (p = 0.634). Peri-procedural hospital stay was significantly shorter in the SDD protocol group (0.50 day vs. 1.52 days, p < 0.001), without a reallocation of health care to outpatient clinic (p = 0.230), emergency department (p = 0.132), or a higher rate of readmission (p = 0.092). Conclusion: The SDD protocol group with 57.7% SDD has similar complication rates and lower healthcare utilization, compared to the national ONS benchmark with 5.3% SDD, indicating that the SDD protocol is a safe and effective alternative for ONS in patients undergoing PVI. The implementation of an SDD protocol results suggests a potential reduction of nationwide healthcare utilization.