Same-Day Discharge After PAD Procedures Safe in Elderly Patients

For patients over age 70, same-day discharge after endovascular therapy for PAD appears to be safe and feasible, new data show, with these elderly individuals being no more likely than younger patients to have complications that require hospitalization and an overnight stay.

Various studies have demonstrated that the same-day practice is safe for younger patients, but it was unknown whether older patients would meet criteria to be safely discharged home and followed up the next day.

In the study, published online October 5, 2017, ahead of print in Catheterization and Cardiovascular Interventions, the frequency of complications within 24 hours of discharge was about 1% in the older patient population, which was comparable to the rate in the younger control group.

“Furthermore, major adverse cardiovascular event rates between the discharge and the follow-up examination after 30 days were also similar,” write investigators led by Adam Janas, MD, PhD (American Heart of Poland, Katowice, Poland). “These results indicate that elderly patients undergoing [endovascular revascularization] of lower extremities could be considered for same-day discharge.”

Increases Comfort, Reduces Delirium

For their nonrandomized study, Janas along with senior author Stefan R. Kiesz, MD (American Heart of Poland) and colleagues looked at 477 consecutive patients treated by balloon angioplasty, atherectomy, or stenting at a freestanding cath lab at the San Antonio Endovascular & Heart Institute (San Antonio, TX). Eligibility for same-day discharge hinged on numerous factors, including: “first on the list” procedures (completed by midday), ability to be discharged within 3 to 5 hours of the procedure, living or staying locally, a companion to stay with the patient overnight, phone access for at least 1 day after discharge, and no acute psychiatric conditions or delirium.

Additionally, patients had 24/7 phone access to qualified nursing staff or, if indicated, to a doctor on call. Prior to discharge, patients were instructed about when and how to call if complications developed and to report any hospitalization occurring before planned follow-up. Barring complications, they returned to the cath lab the next day for follow-up.

Same-day discharge criteria were met in approximately 99% of patients, regardless of age. There were no deaths, TLRs, amputations, MIs, strokes, or increases in serum creatinine within 24 hours.

According to Janas and colleagues, extending the same-day discharge practice to elderly patients may have the added benefits of improving patient comfort and helping to avoid delirium. “In most cases, patients spend the night at home in a well-known environment with the close ones around,” they write. “This factor is especially important for patients with dementia, which is another well-described risk factor for delirium.”

In an email, Janas said that while some elderly patients might choose a hospital stay, the patients and their families who were included in the study reacted positively to same-day discharge and were happy to have the opportunity to go home.

“The burden of cardiovascular disease is growing; therefore, same-day discharge could improve cost-effectiveness of endovascular revascularization of the lower extremity,” he added.