RESUMO
PURPOSE: Most centers performing catheter ablation (CA) of atrial fibrillation (AF) admit the patients for an overnight hospital stay to monitor for post-procedure complications, but the clinical benefits of this overnight hospital admission policy have not been carefully investigated. We hypothesized that same-day discharge strategy is safe and feasible in patients with AF undergoing CA. METHODS: A systematic review of studies comparing the safety of same-day discharge vs hospital admission for AF patients undergoing CA was conducted in PubMed/MEDLINE, Embase, Scopus, and Web of Science. No randomized controlled trials met the inclusion criteria; therefore, observational cohort studies were included. Mantel-Haenszel risk ratios were calculated and I2 statistics were reported for heterogeneity assessment. RESULTS: A total of 8 observational studies with 10,102 patients were included. There were no statistically significant differences between same-day discharge vs hospital admission in all studied outcomes including post-discharge 30-day hospital visits (RR: 0.90; 95% CI: 0.40-2.02; p = 0.81), post-discharge vascular/bleeding complications (RR: 0.93; 95% CI: 0.46-1.88; p = 0.85), post-discharge stroke/transient ischemic attack/thromboembolism (RR: 0.70; 95% CI: 0.23-2.20; p = 0.55), and post-discharge recurrent arrhythmias (RR: 0.81; 95% CI: 0.60-1.09; p = 0.1). CONCLUSION: In carefully selected AF patients undergoing CA, same-day discharge strategy is feasible and safe. There are no significant differences in post-discharge 30-day hospital visits, post-discharge vascular complications, and other safety outcomes. Randomized trials are needed to validate these hypothesis-generating findings.
Assuntos
Fibrilação Atrial , Humanos , Fibrilação Atrial/cirurgia , Assistência ao Convalescente , Alta do PacienteRESUMO
BACKGROUND: Patients with acute hepatitis A virus (HAV) infection are at risk of developing acute kidney injury (AKI) which may result in increased healthcare resource utilization and worse clinical outcomes. We investigated the impact of AKI on healthcare utilization and clinical outcomes in patients hospitalized with acute HAV infection utilizing a large database. METHODS: We queried the National Inpatient Sample (NIS) 2007-2014 to identify acute HAV infection-related hospitalizations with and without AKI. Primary outcomes were prevalence of AKI and its predictors with secondary outcomes included the mean length of stay (LOS), hospitalization cost and mortality in both groups. RESULTS: Out of 68 364 acute HAV infection-related hospitalizations, 47 620 met our study criteria and 7458 (15.7%) had concurrent AKI. HAV patients with AKI were older (62.5 vs. 53.7 years; P value <0.001). A higher mean LOS (10.03 vs. 5.6 days; P value <0.001) and mean total hospitalization cost ($27 171.35 vs. $12 790.26; P value <0.001) were observed in HAV patients with the AKI group. A total of 1032 patients (13.8%) in the AKI group died during the same hospitalization as compared to 681 patients (1.5%) in the non-AKI group, P value <0.001. AKI in HAV was also found to be an independent predictor of mortality [adjusted odds ratio (aOR), 3.28; 95% confidence interval, 2.23-4.84; P value <0.001) after adjusting for the confounding factors. CONCLUSION: We found that 15.67% of patients hospitalized with acute HAV had AKI which contributed to increased healthcare utilization and higher mortality which is preventable.
