Improved patient value after implementing same day discharge for patients undergoing pulmonary vein isolation

Abstract

Abstract Aims Pulmonary vein isolation (PVI) is an effective intervention to treat atrial fibrillation, which is increasingly prevalent. Same-day discharge (SDD) is a strategic approach to limit procedure-related costs. This study aimed to compare healthcare utilization, costs, and clinical outcomes before and after implementation of an SDD protocol. Methods and results This retrospective study included 2987 patients undergoing PVI between 1 January 2016 and 1 April 2021. Baseline characteristics, pre-, peri-, and post-procedure healthcare utilization and clinical outcomes were compared before (cohort A; n = 1379) and after (Cohort B; n = 1608) implementation of the SDD protocol using bivariate and multivariate analyses. show that cohort B vs. cohort A had lower all-cause 90-day mortality (0% vs. 0.3%, P = 0.031), no differences in re-ablation < 1 year (P = 0.286), as well as in complications: bleedings (P = 0.177), tamponade < 30 days (P = 0.157), phrenic nerve injury (P = 0.984), thromboembolic complication < 72 h (P = 0.212), or vascular complications (P = 0.290). In terms of healthcare utilization and costs, cohort B had significantly less peri-procedure hospital admission costs (€721.52 vs. €1011.78, P < 0.001) and less total peri- and post-procedure costs (€840.37 vs. €1152.94, P < 0.001). Adjusted for all baseline characteristics, the post-implementation cohort showed on average €315 lower total costs per patient. Conclusion The implementation of the SDD protocol was associated with comparable complication rates while significantly reducing both peri- and post-procedure healthcare utilization and costs, thereby enhancing patient value. This indicates a potential margin for further cost reductions and increased efficiency.