Medical Student University of Alabama at Birmingham, United States
Purpose: The objective of this study is to evaluate whether the institutional transition from routine overnight observation to same-day discharge after percutaneous ablation (PA) of liver tumors is associated with a significant increase in major adverse events (AEs) and 30-day readmission rates.
Materials and Methods: This single-center retrospective study included 217 adult patients. Patients who underwent percutaneous ablation (PA) in 2018–2019 and were routinely admitted for overnight observation were designated as the control group (Group A). Patients treated in 2021–2022, following the implementation of a same-day discharge protocol, comprised the test group (Group B). Data collection included demographics, tumor characteristics and clinical outcomes. Categorical variables were analyzed using the chi-square test, while continuous variables were assessed with a two-sample t-test. Logistic regression analysis was performed to identify predictive factors for major adverse events (AEs) and 30-day readmission rates.
Results: Thirteen patients (5.9%) from the total cohort were re-admitted to the hospital within 30 days for any reason. Four patients (5.3%) and nine patients (6.3 %) were re-admitted for any reason within 30 days in Group A and Group B, respectively, with no difference between the two groups (p = 0.95). Logistic regression analysis found no significant predictive variables for 30-day readmission rates. Nine patients (4.2%) from the cohort experienced major adverse events. Two patients in Group A (2.7%) and seven patients in Group B (4.9 %) had major AEs following liver ablation, with no difference between the two groups (p = 0.25). Logistic regression analysis of the cohort found that tumor diameter was a significant predictive variable of major adverse events (OR 1.89, 95% CI 0.97-3.52, p = 0.05).
Conclusion: After the institutional transition to same-day discharge, there was no significant increase in major adverse events or 30-day readmission rates compared to the prior routine of overnight observation.These findings suggest that same-day discharge is a safe and effective protocol that can be maintained in institutional practice without increasing adverse clinical outcomes following PA. Continuation of this approach has the potential to reduce healthcare costs, decrease inpatient admission rates, and enhance patient outcomes by allowing individuals to recover in the comfort of their own homes. Additionally, tumor diameter was observed to be as an important factor for physicians to consider when stratifying the risk of adverse events and making discharge decisions.
