Thirty-day readmission rate of same-day discharge protocol after left atrial appendage occlusion: A propensity score–matched analysis from the National Readmission Database

Background: Given the reduction in periprocedural complication rates, same-day discharge (SDD) after percutaneous left atrial appendage closure (LAAC) could be beneficial. To date, little data exist comparing the standard overnight stay (ONS) vs SDD after LAAC. Objective: The purpose of this study was to investigate the safety and efficacy of SDD compared with ONS. Methods: A retrospective cohort study of LAAC procedures performed in the United States from 2015 to 2019 was conducted using the US Nationwide Readmission Database. The primary outcome was all-cause 30-day readmission after discharge in patients who underwent LAAC, and a secondary outcome was requiring total health care cost. A 1:1 propensity score matching was conducted for adjustment. Multivariate Cox proportional hazards regression was also performed to estimate the hazard ratio for all-cause readmission within 30 days of LAAC. Results: Of 48,953 patients (mean age 76.0 ± 7.9 years), 972 patients (1.99%) were discharged on the same day after LAAC (SDD group) and the remaining 47,981 patients stayed at least 1 night (ONS group). A propensity score–matched analysis generated 961 matched pairs in each group. The 30-day readmission rate after discharge was similar between the groups (SDD vs ONS: 8.5% vs 9.8%; P = .31; hazard ratio 1.13; 95% confidence interval 0.78–1.63; P = .53). The total required health care cost was significantly lower in the SDD group ($23,720 [$18,075–$29,416] vs $25,877 [$19,906–$32,748]; P < .01). Gastrointestinal bleeding was the major cause for readmission (SDD vs ONS: 14.7% vs 15.1%; P = .95), but stroke and pericardial effusion were rare. Conclusion: In patients without procedure-related complications, SDD is a safe and cost-effective protocol.