4539. Effects of Same Day Discharge Versus Overnight Observation on Readmission Rates and Mortality After Transarterial Chemoembolization
Authors * Denotes Presenting Author
  1. Dakota Williams *; The University of Alabama at Birmingham
  2. Matt Raymond; The University of Alabama at Birmingham
  3. Russ Guidry; The University of Alabama at Birmingham
  4. Aliaksei Salei; The University of Alabama at Birmingham
  5. Andrew Gunn; The University of Alabama at Birmingham
This study aims to evaluate if patients discharged the same day after transarterial chemoembolization (TACE) experienced more readmissions within 30 days of the procedure or increased mortality when compared to patients who were observed overnight.

Materials and Methods:
Single institution retrospective analysis of 348 patients who underwent 529 TACE procedures for hepatocellular carcinoma between January 2019 and June 2022 was performed. The decision to discharge the patient or observe overnight was made by the performing interventional radiologist following a standard postprocedural recovery period. Factors associated with the decision to observe the patient overnight were analyzed utilizing a chi-square and Fisher exact test for categorical variables and Wilcoxon rank-sum test overnight cohort were compared with chi-square analysis and Fisher exact test, respectively.

There were no differences between the same day discharge and overnight observation patients with regard to age, sex, Child-Pugh score (CPS), MELD score, or Charlson comorbidity index. African American patients (<em>p</em> = 0.008), those with advanced BCLC stage (<em>p</em> = 0.006), viral hepatitis (<em>p</em> = 0.004), higher ECOG performance status score (<em>p</em> = 0.004), undergoing TACE with general anesthesia (<em>p</em> < 0.001) and with higher postprocedural pain scores (<em>p</em> < 0.001) were more likely to be observed overnight. 22 readmissions out of 366 TACE procedures with same-day discharge, and 14 out of 163 with overnight observation were recoded within 30 days (6.0% vs 8.6%). Six patients died within 30 days following same day discharge and four following overnight observation (1.6% vs 2.5%). Chi square analysis showed no significant different in 30-day readmission for patients with same-day discharge versus the overnight cohort (<em>p</em> = 0.2770). Similarly, there was no significant difference in death rate using the Fisher exact test between those discharged same-day versus those kept overnight (<em>p</em> = 0.5062). Same-day discharge following TACE is not associated with an increased 30-day readmission rate or increased mortality rate.

This research shows that same-day discharge after TACE does not lead to increased readmission rates and mortality. Same-day discharge after TACE can reduce costs to the health system associated with the procedure and improve the overall patient experience.