Co-Author(s):
Chi Zhang, MD
Mohit Turagam, MD
Noelle Langan, MD
Aamir Sofi, MD
Subbarao Choudry, MD
Georgios Syros, MD
Marc Miller, MD
Jacob Koruth, MD
William Whang, MD
Srinivas Dukkipati, MD
Vivek Reddy, MD
Icahn School of Medicine at Mount Sinai
1468 Madison Avenue, New York, NY 10029
Introduction | Objectives: Although post-procedure care after catheter ablation for atrial fibrillation (AF) has historically necessitated overnight stay, same-day discharge (SDD) after the ablation procedure is feasible and increasingly being considered. This study examined the barriers and financial impact associated with SDD in a contemporary cohort of patients undergoing elective AF ablation.
Methods: A single center retrospective review was conducted of all first case-of-the-day outpatient AF ablations performed in 2019.  The primary outcome was the proportion of patients that could have undergone SDD.  Barriers to discharge were defined as any non-routine intervention that prevented SDD.  The financial impact of SDD was based on savings from avoidance of the overnight hospital stay and revenue related to management of chest pain facilitated by a vacant hospital bed.
Results: Of the 249 patients who underwent AF ablation, SDD could have occurred in 157 patients (63%) without change in management and in up to 200 patients (80%) if avoidable barriers were addressed.  Barriers to SDD included non-clinical logistical issues (43%), prolonged post-procedure recovery (42%) and minor procedural complications (15%), as shown in the figure.  The financial gain from SDD would have ranged from $1,108,692 (assuming discharge of 63% of eligible patients) to $1,478,256 (assuming 80% discharge) over the course of a year.
Conclusions: Up to 80% of patients undergoing outpatient AF ablation were amenable to SDD if avoidable delays in care had been anticipated.  Based on reduced hospital operating expenses and increased revenue from management of individuals with chest pain, this would translate to a financial savings of ~$1.5 million.
AFS 2021-19