Do Patients Need to Stay the Night After Stenting?

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Some elderly patients getting a heart stent can leave the hospital the same day with no extra risk of complications, suggests a new study.

Researchers said that the findings only apply to people with a low risk of complications such as bleeding or heart attack and who have family or friends to support them at home.

"There are probably going to be some patients who feel comfortable staying overnight and that's fine, but I'm guessing most patients would prefer to go home," said study author Dr. Sunil Rao, from the Duke Clinical Research Institute in Durham, North Carolina.

Rao and his colleagues examined data from more than 100,000 non-emergency stenting procedures, done to open up narrowed coronary arteries, in adults age 65 and older.

Just over one percent of those patients went home the same day as the procedure. The rest stayed at the hospital for the night.

Rao said that patients are typically kept overnight so doctors can make sure they don't have any bleeding complications or problems with their newly-inserted stent.

But as it turned out, the rates of bleeding and blood vessel related complications were each less than one percent regardless of whether or not patients stayed in the hospital, the researchers reported in the Journal of the American Medical Association.

And people who were sent home early weren't any more likely to have to return to the hospital, or to die, than those who were kept longer for observation.

By 30 days after the procedure, 9.6 percent of patients who were discharged on the same day had died or been re-admitted to the hospital, compared to 9.7 percent who had an overnight stay.

People who left the hospital on the same day as their procedure generally were at low risk of complications and future heart problems.

For a same-day discharge to work, "you have to have a successful procedure with no complications," Rao told Reuters Health. Patients, he added, "also have to have a social support network at home. They have to have someone who, if they do get in trouble, can call for help."

Rao said that when he sends patients home with a new stent, he tells them to watch out for chest pain, as well as swelling, bruising and bleeding. Those patients also have to make sure they take their medications, including anti-platelet therapy, to prevent stent-related complications.

"If we're talking about a patient who is in relatively good health, who you do an angioplasty on and get a good result, you observe them for 8 hours... the ability to send them home is real," said Dr. Carl Tommaso, from North Shore University Health System in Skokie, Illinois, who was not involved in the new study.

He told Reuters Health that while keeping patients overnight is still considered best practice, there's a trend toward more people getting sent home after 8 to 10 hours.

Rao added that for the right hospitals, sending certain low-risk people home would save beds and nurses needed by other patients.

The new study, Rao said, "should provide (heart doctors) with even more reassurance" that complications are rare after non-emergency stent procedures, and that it may be safe to send some patients home early with a plan and supportive caregivers.

Tommaso said that patients should follow their doctor's advice after getting a stent. "Don't push a doctor to go home the same day if it's a complex procedure," he said.