Introduction:
In January 2020, Medicare began reimbursing for percutaneous coronary intervention (PCI) performed in ambulatory surgery centers (ASCs), but little is known about characteristics and outcomes of patients who have undergone ASC PCI previously.
Methods:
Using commercial insurance claims from the MarketScan® Databases, we characterized patients 18 years or older who underwent hospital outpatient department (HOPD) or ASC PCI for stable ischemic heart disease between April 1, 2007, and December 1, 2016. We used propensity score matching of HOPD and ASC PCI cohorts to measure the association between treatment setting and 30-day outcomes (myocardial infarction, bleeding complications, and all-cause admission).
Results:
The unmatched sample consisted of 95,492 HOPD and 849 ASC PCI patients. Patients were more likely to undergo ASC PCI if they were younger than 65 (OR 1.72, 95% CI 1.43-2.06), lived in the southern U.S., or were covered by managed (OR 2.31, 95% CI 1.73-3.08) or consumer-driven (OR 2.57, 95% CI 1.73-3.82) compared to comprehensive health plans. ASC PCI was less likely in patients with a history of stroke (OR 0.45, 95% CI 0.28-0.72). Intravascular imaging and physiology testing were more frequently performed in HOPD than in ASC PCI (18.3% vs. 12.5%, respectively; p < 0.001). After propensity-score matching, ASC PCI was associated with increased odds of bleeding complications (OR 2.43, 95% CI 1.22-4.84, p = 0.011). Differences in other outcomes were not statistically significant.
Conclusions:
Patients undergoing outpatient elective PCI in ASCs were younger and more likely to live in the southern U.S or have managed or consumer-driven health insurance plans. Intravascular imaging and physiology testing were performed more frequently in HOPD than in ASC PCI. PCI in the ASC setting was also associated with an increased risk of bleeding complications. Further study of this population is warranted as ASC PCI volume increases under Medicare.
Elective Percutaneous Coronary Intervention in Ambulatory Surgery Centers
