Timing of discharge of pediatric patients post cardiac catheterization

Abstract

BACKGROUND: Same-day discharge after cardiac catheterization may be safe for some patients. This study aimed to review our experience with same-day discharge after pediatric cardiac catheterization following the implementation of a fast-track protocol. OBJECTIVES: Evaluate the feasibility of same-day discharge after pediatric cardiac catheterization and identify risk factors for prolonged hospital stay. DESIGN: Retrospective review SETTING: Pediatric cardiology department PATIENTS AND METHODS: Data from patients who underwent cardiac catheterization were recorded over 17 months, from January 2022 to May 2023, focusing on pediatric cardiac catheterization procedures, including demographics, clinical, echocardiographic, catheterization data, and outcomes. Criteria were set to determine the possibility of same-day discharge post-cardiac catheterization. MAIN OUTCOME MEASURES: The primary outcome was the length of hospital stay post-cardiac catheterization. Secondary outcomes included identifying risk factors for prolonged hospital stay (more than 12 hours) and any associated complications. SAMPLE SIZE: 300 patients RESULTS: Of the 300 patients, 201 (67%) were discharged on the same day (with less than 12 hours' hospital stay), and 57 patients (19%) stayed overnight. The median length of stay (LOS) after pediatric cardiac catheterization was 8.7 hours (25th percentile: 7.5 hours, 75th percentile: 23.8 hours). No complications were reported in patients discharged on the same day. The majority of procedures were interventional cardiac catheterizations (242 cases, 80.7%), with most patients (166 cases, 55.3%) discharged on the same day of the procedure. The most common age group was between 3 to 6 months (114 patients, 38%). Regression analysis revealed that cardiac catheterization in neonates and infants less than 3 months old, more complex interventions such as patent ductus arteriosus stenting and right ventricular outflow tract stenting, interventions in the aortic valve, and the occurrence of complications were associated with prolonged hospital stay. CONCLUSION: Same-day discharge following catheterization is feasible for the majority of pediatric patients and can contribute to reduced healthcare costs and improved patient satisfaction. We developed a fast-track protocol for assessing the timing of discharge after pediatric cardiac catheterization, outlining potential indications and contraindications for same-day discharge. Factors associated with prolonged hospital stays include interventions in the neonatal period and procedure-related complications. Careful patient selection and monitoring impleare essential to ensure optimal outcomes LIMITATIONS: The retrospective nature of the study and the single-center experience may limit the generalizability of the findings.