Same-Day Discharge After Left Atrial Appendage Closure and Early Readmissions: A 5-Year National Readmissions Database Analysis.

BACKGROUND

Same-day discharge (SDD) after left atrial appendage closure (LAAC) may reduce hospitalization burden, but concerns regarding early readmission after discharge remain.

METHODS

We performed a retrospective cohort study using the Nationwide Readmissions Database from 2016 through 2020. Adult patients undergoing inpatient LAAC were identified using International Classification of Disease-10 procedure code 02L73DK. The analytic cohort was restricted to length of stay (LOS) 0 or 1 day; SDD was defined as LOS 0 and overnight stay as LOS 1. Survey-weighted modified Poisson regression was used to estimate adjusted risk ratios (RRs) with year-specific hospital-clustered SEs. Models adjusted for demographics, insurance, income quartile, hospital characteristics, hospital LAAC volume, calendar year, and selected comorbidities.

RESULTS

Among the 39,705 index LAAC hospitalizations, 1621 (4.1%) were SDD and 38,084 (95.9%) were overnight stay. SDD increased from 1.6% in 2016 to 7.7% in 2020. Crude 7-day readmission was 2.0% after SDD versus 2.4% after overnight stay, and 30-day readmission was 7.0% versus 7.6%, respectively. After adjustment, SDD was not associated with higher 7-day readmission (RR 0.89; 95% CI 0.62-1.29) or 30-day readmission (RR 1.00; 95% CI 0.82-1.22). Results were similar in missing-data and overlap-weighted sensitivity analyses. Common readmission categories included bleeding/anemia, cardiovascular/thromboembolic causes including heart failure/volume overload, infection/sepsis, and arrhythmia/conduction disorders.

CONCLUSIONS

Among selected short-stay inpatient LAAC procedures, SDD increased over time and was not associated with higher early readmission compared with overnight observation. These findings should be interpreted as reflecting outcomes among patients selected for SDD rather than evidence supporting universal SDD after LAAC.