Outpatient percutaneous coronary intervention: has its time come?

In the context of the rising health-care costs in the United States and the fact that approximately 1 million percutaneous coronary intervention (PCI) procedures are performed in the United States annually with a cost approaching $10 billion, reducing the cost associated with this frequently performed effective procedure has become paramount. Government and insurance-based methods have focused upon appropriate utilization and, in some cases, payment has been denied for procedures deemed inappropriate. While curtailing procedures may sometimes be reasonable, this approach is fraught with trouble, as individualized patient care does not fit neatly into population-based concepts of appropriateness. Therefore, alternative means to minimize expenditures should be entertained. Chief among these is the potential to reduce costs associated with PCI from prolonged inpatient stays for a procedure that, thankfully, has become significantly safer as it has maintained its efficacy. In this position paper, we discuss the theme of same-day discharge versus overnight stay after PCI as a cost-saving strategy, and pinpoint some criteria that can help to guide such a decision while preserving maximal patient safety and both patient and physician satisfaction.