Not everyone needs an overnight hospital stay after this artery-opening procedure.
Artery-opening angioplasty is an amazing procedure. It lets a doctor restore blood flow to hard-working heart muscle without having to cut into the chest or split the rib cage. Assuming all goes well, the recovery time is minimal and the only physical reminder of the procedure is a half-inch scar at the top of one leg.
Standard procedure calls for spending a night in the hospital after angioplasty, even though some people want to go home the same day and could do so safely. Some doctors and insurers are questioning the need for, and the expense of, the routine post-angioplasty hospital stay.
At Mt. Sinai Medical Center in New York, more than 2,400 men and women have skipped the overnight stay and gone home a few hours after routine, uncomplicated angioplasty. At-home recovery proved to be as safe as in-hospital recovery — there were no deaths, heart attacks, or strokes, and just 14 people had minor bleeding from the small incision above the femoral artery in the groin that provides access for the angioplasty equipment (JACC Cardiovascular Interventions, August 2010).
About one-third of the hospital's angioplasty patients now skip the hospital stay and go home the same day as the procedure, says Dr. Samin Sharma, director of Mt. Sinai's interventional cardiology program and an author of the study. To do so, they must meet strict guidelines (see "Criteria for same-day discharge").
Criteria for same-day discharge
The Mt. Sinai team used these criteria to determine who might safely go home the same day of angioplasty:
under 65 years of age
no diabetes or controlled diabetes
good kidney function
no heart failure
good ejection fraction (greater than 30%)
angioplasty not performed for heart attack
no major complications or minor mishaps during the procedure
bleeding stopped quickly at catheter access site in the groin
patient can walk 200 meters or more soon after the procedure without any bleeding from the access site
social support, including someone to drive the patient home from the hospital and a working home or cell phone for a follow-up call after the procedure.
In 2009, the Society for Cardiovascular Angiography and Interventions published guidelines on length of stay after angioplasty. Although the guidelines say that same-day discharge after uncomplicated angioplasty is feasible, they weren't based on much data, something the Mt. Sinai study provides.
A hospital is the place to be when you need specialized medical care. But don't linger there longer than necessary. The more time you spend in a hospital, the greater the chances of picking up a nasty infection or being the victim of a medication mix-up or other error. Your own bed is more comfortable than a hospital bed, your home quieter, and your food more appealing.
Going home a few hours after angioplasty isn't for everyone. But if you meet the criteria, have the procedure early in the day, and want to sleep in your own bed, the Mt. Sinai experience suggests you should do just that.
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