Longer hospital stays after elective PCI mean higher costs, more readmissions

The shorter a patient’s hospital stay after elective percutaneous coronary intervention (PCI), the better, according to recent research out of the U.K. that linked longer lengths of stay to an increase in unplanned readmissions and healthcare costs.

“Length of stay (LOS) in PCI is an area of interest because a significant proportional cost of the procedure is associated with LOS in hospital,” corresponding author Mamas Mamas, DPhil, BMBCh, and colleagues wrote in the American Journal of Cardiology this fall. “To date, several studies have been conducted demonstrating the safety of same-day discharge (SDD) in the elective setting.”

But those studies didn’t consider readmission rates—or the price tag associated with them—as factors, Mamas, of Keele University in Stoke-on-Trent, U.K., and co-authors said. While SDD theoretically cuts costs, it’s unknown whether any of its patients experience unplanned readmissions within a month of the procedure, offsetting those initial savings.

Mamas et al. included 324,345 patients from the Nationwide Readmission Database in their study, all of whom were admitted to the hospital for uncomplicated, elective PCI between 2010 and 2014. The researchers divided the pool by LOS, which was capped at 3 or more days.

Unplanned 30-day readmissions were as follows:

  • 4.75 percent in SDD patients

  • 4.67 percent in patients discharged after one day

  • 6.44 percent in patients discharged after two days

  • 9.42 percent in patients discharged after three or more days

Prolonged LOS also correlated with increased average total 30-day costs, the authors said. Index and readmission costs topped out at $15,063 for SDD patients, $14,693 for patients discharged after a day and $18,136 for those discharged after two days. Costs were significantly higher for patients released after three or more days, reaching an average of $24,336.

“The major clinical implication of the current study is that there does not appear to be increased risk of readmissions with SDD and shorter LOS in elective PCI,” Mamas and colleagues wrote. “Unlike previous studies, which focus on LOS as a binary categorical variable, our results provide further granularity through consideration of length of stay in a graded manner.”

Though LOS was a significant variable in the study, readmission risk seemed most influenced by age, female sex and patients’ comorbidities. Longer length of stay was associated with an increase in readmissions for heart failure but a reduced incidence of readmissions for non-cardiac causes—something the authors said might be a result of better in-hospital management of a patient’s comorbidities.

“Our study provides several important findings,” Mamas et al. wrote. “In the increasing cost-conscious and evidence-based healthcare system, results from the current analysis suggest that SDD and shorter lengths of stay in elective patients are not associated with increased rates of unplanned readmission and that the savings achieved with shorter LOS are not offset by increased total healthcare costs at 30 days driven by unplanned readmissions.”