Same day/early discharge for TAVI – changing practice in the UK

Abstract

Introduction: At University Hospital of Coventry and Warwickshire (UHCW) we have been looking at the possibility of implementing same-day or early discharge (SDD/ED) for low-risk Transcatheter Aortic Valve Implantation (TAVI) patients who have had no significant procedural complications. The current median length of stay in the UK is 3 days, often due to concerns about delayed complications including arrhythmias, infection, vascular complications and stroke. Studies have shown that the rate of re-admission within 30 days after SDD vs different-day discharge is not significantly different. UHCW has implemented a minimalist TAVI approach and expedited discharge processes, including early mobilisation and discharge advice to patients about potential complications. Consequently, UHCW has a median length of stay of one day (shortest in the UK).

Aims: To review our data to ensure that patients were receiving safe and effective treatment while having a short hospital stay.

Methods: Retrospective analysis of 157 patients who underwent TAVI at UHCW in 2023. 87 of these patients underwent elective procedures.

Results: In patients that had an uncomplicated procedure, none that were discharged early suffered a delayed complication due to their TAVI procedure. In those that suffered complications, these were identified peri-procedurally and not after discharge.*

Conclusions: Same day/early discharge appears feasible without compromising patient safety. Discharging patients earlier will allow us to reduce hospital-borne complications, accelerate patient recovery, lower healthcare costs, and improve patient flow through the hospital. We will look to confirm these results with a prospective study.