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Hund HC, Frantz SK, Wu H, Adeniran OR, Wong TY, Borgmann AJ, Matsuoka L, Geevarghese S, Alexopoulos S, Shingina A, Meranze SG, Baker JC, Garbett S, Brown DB. Six-Year Evaluation of Same-Day Discharge following Conventional Transarterial Chemoembolization of Hepatocellular Carcinoma. J Vasc Interv Radiol 2023; 34:378-385. [PMID: 36481322 DOI: 10.1016/j.jvir.2022.11.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/09/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To evaluate whether same-day discharge increased the incidence of 30-day readmission (30dR) after conventional transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) at a single institution. MATERIALS AND METHODS In this retrospective study, 253 patients with HCC underwent 521 transarterial chemoembolization procedures between 2013 and 2020. TACE was performed with 50-mg doxorubicin/10-mg mitomycin C/5-10-mL ethiodized oil/particles. Patients not requiring intravenous pain medications were discharged after a 3-hour observation, and 30dR was tracked. The primary objective was to determine the incidence of 30dR in same-day discharge patients versus patients admitted for observation using the chi-square test. Secondary objectives assessed factors associated with overnight admission and factors predictive of 30dR using generalized estimated equation calculations and logistic regression. RESULTS In the cohort, 24 readmissions occurred within 30 days (4.6%). Same-day discharge was completed after 331 TACE procedures with sixteen 30dRs (4.8%). Patients admitted overnight were readmitted 8 times after 190 TACE procedures (4.2%). This difference was not statistically significant (P = .4). Factors predicting overnight admission included female sex (58/190 [30.5%] vs 58/331 [17.5%], P < .001) and tumor size of ≥3.8 cm (104/190 [55%] vs 85/190 [45%]). Factors predicting 30dR included female sex (10/116 [8.6%] vs 14/405 [0.2%]) and younger age (median [interquartile range], 63 years [55-65 years] vs 65 years [59-71 years]). At regression, factors predictive of 30dR were Child-Pugh Class B/C (odds ratio [OR], 2.1; P = .04) and female sex (OR, 2.9; P = .004). CONCLUSIONS Same-day discharge after conventional TACE is a safe and effective strategy with 30dR rate of <5%, similar to overnight observation.
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Affiliation(s)
- Hannah C Hund
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Shelby K Frantz
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Hui Wu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Oladapo R Adeniran
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas Y Wong
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Anthony J Borgmann
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lea Matsuoka
- Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sunil Geevarghese
- Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sophoclis Alexopoulos
- Division of Hepatobiliary Surgery and Liver Transplantation, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alexandra Shingina
- Division of Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Steven G Meranze
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jennifer C Baker
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shawn Garbett
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Daniel B Brown
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee.
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Nikolic B. The 30-day Readmission Metric: Time for Interventional Radiology to Be on Board. Radiology 2019; 290:730-731. [PMID: 30599100 DOI: 10.1148/radiol.2019182707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Boris Nikolic
- From Cooley Dickinson Hospital, a Massachusetts General Hospital Affiliate, 30 Locust St, Northampton, MA 01060
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Outpatient Transarterial Chemoembolization of Hepatocellular Carcinoma: Review of a Same-Day Discharge Strategy. J Vasc Interv Radiol 2018; 29:550-555. [DOI: 10.1016/j.jvir.2017.11.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/13/2017] [Accepted: 11/19/2017] [Indexed: 02/08/2023] Open
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