Same-day discharge protocol linked to lower costs after pulmonary vein isolation

A retrospective study published in Europace compared healthcare utilization, costs, and clinical outcomes before and after implementation of a same-day discharge protocol for pulmonary vein isolation in patients with atrial fibrillation. It included 2,987 patients treated between 1 January 2016 and 1 April 2021: 1,379 before implementation and 1,608 afterward. Analyses included comparisons adjusted for baseline characteristics.

The post-implementation cohort had lower peri-procedure hospital admission costs (€721.52 versus €1,011.78) and lower total peri- and post-procedure costs (€840.37 versus €1,152.94; both P < 0.001). After adjustment, total costs were approximately €315 lower per patient. All-cause 90-day mortality was 0% after implementation versus 0.3% before implementation (P = 0.031). There were no statistically significant differences in re-ablation within one year, bleeding, tamponade within 30 days, phrenic nerve injury, thromboembolic complications within 72 hours, or vascular complications.

These findings support the potential for same-day discharge protocols to reduce costs after pulmonary vein isolation. However, the nonrandomized before-and-after design cannot establish causality or exclude changes in care over time. Nonsignificant complication comparisons do not establish equivalent safety. Only the abstract was available, limiting assessment of discharge eligibility, actual same-day discharge rates, and applicability to other settings.