Impact of the COVID-19 Pandemic on Same-day Discharge Adoption Following Percutaneous Coronary Intervention for Stable CAD: A National Time Series Analysis

Background Elective percutaneous coronary intervention (PCI) historically required hospitalization post procedure. Same day discharge (SDD) has emerged as a safe and cost efficient option, although the impact of the coronavirus disease of 2019 (COVID-19) pandemic on rates of SDD and associated care episode costs remains uncertain. Methods A national sample of consecutive patients undergoing elective PCI at 42 hospitals (Ascension, St.Louis, MO) between May 2019 to April 2021 were identified using internal registry data and administrative claims data. Rates of SDD before and after the COVID-19 pandemic (March 2020) were compared using multivariable logistic regression adjusted for patient and procedural characteristics. Additionally, an interrupted time series model was used to determine the effect of the pandemic and policy on SDD rates before and after pandemic declaration. Lastly, we estimated total costs per PCI episode in pre and post pandemic periods. Results In total, 12,740 interventions were performed within 42 Ascension facilities that met study eligibility criteria (5955 PCI prior to the pandemic and 6785 after). Demographic data were similar between both populations although higher rates of dyslipidemia, prior myocardial infarction, and heart failure history were noted in the post pandemic group. Pandemic declaration was associated with a higher likelihood of SDD (OR 2.09, CI 1.93-2.25, p < 0.001). From pre-pandemic to post-pandemic, mean SDD rose from 34% to 45% (p< 0.001) with an accelerated monthly SDD adoption rate after the pandemic (0.1% per month vs 1.0% per month, p=0.02). Total costs per episode were $679.52 (95% CI $476.12 – $882.92, p < 0.001) higher in the post-pandemic period, driven by increased material costs. SDD was associated with a $2137.05 (95% CI $1925.03 – $2349.07, p < 0.001) reduction in costs relative to non-SDD episodes throughout the study period. Conclusion Among a large national risk-adjusted sample of consecutive patients, the COVID-19 pandemic accelerated adoption of SDD. As a care strategy, SDD was associated with reduced episode costs during elective PCI in the post-pandemic period. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement No Funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: IRB from the Dell School of Medicine IRB from the Ascension Health System I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable All data used in this analysis are available in our secured system for clarification and additional analysis as needed.