Search

Background Due to the current Coronavirus Disease 2019 (COVID-19) pandemic, there is a realization for innovation in procedures and protocols to minimize hospital stay and at the same time ensure continued evidence-based treatment delivered to the patients. We present a same-day discharge protocol for transcatheter mitral valve repair (TMVR) using MitraClip under general anaesthesia in a six-patient case series. This protocol aims to reduce the length of hospital stay, thereby minimizing potential for nosocomial COVID-19 infections and to promote safe discharge with cautious follow-up. Case summary Six patients with severe symptomatic mitral valve (MV) regurgitation underwent successful transfemoral MV repair using standard procedures. Following repair, patients were monitored on telemetry in the recovery area for 3 h, ambulated to assess vascular access stability and underwent post-procedural transthoracic echocardiogram to assess for any pericardial effusion or post-procedural prosthetic mitral stenosis. Conclusion Same-day discharge after TMVR is possible when done cautiously with close follow-up, can minimize hospital stay, improve resource utilization, and reduce risk of nosocomial COVID-19 infection.

Background The coronavirus disease 2019 (COVID-19) pandemic has resulted in drastic changes to the practice of medicine, requiring healthcare systems to find solutions to reduce the risk of infection. Using a case series, we propose a protocol for same-day discharge (SDD) for selected patients undergoing transcatheter aortic valve replacement (TAVR) using real-time remote cardiac monitoring. Six patients with severe symptomatic aortic stenosis underwent TAVR and were discharged on the same day. Case summary Six patients with symptomatic severe native or bioprosthetic aortic valve stenosis underwent a successful transfemoral TAVR using standard procedures, including the use of rapid atrial pacing to assess the need for permanent pacemaker implantation. Following TAVR, patients were monitored on telemetry in the recovery area for 3 h, ambulated to assess vascular access stability, and discharged with real-time remote cardiac monitoring if no new conduction abnormality was observed. The patients were seen by tele-visits within 2 days and 2 weeks after discharge. Discussion Amidst the COVID-19 pandemic, SDD following successful transfemoral TAVR may be feasible for selected patients and reduce potential COVID-19 exposure.

INTRODUCTION Inflammatory bowel disease (IBD) patients with colonic involvement are known to have microbiome changes which may increase their risk of C. difficile infection (CDI). We conducted an analysis to describe the implications of CDI on hospitalized IBD patients. METHODS We used the National Inpatient Sample database from 2007 through 2018, to identify patients admitted with primary or secondary diagnosis of IBD using the ICD-9 or ICD-10 codes. We identified CDI as well as colectomy using diagnostic codes. We identified trends in nationwide estimates for annual admissions, age at admission, length of stay (LOS), in-patient mortality, Elixhauser comorbidity index and total hospital charge (adjusted for inflation). We used the Cochran-Armitage test for trend significance. RESULTS Between 2007 and 2018, there were an estimated total of 3,728,348 admissions with IBD, of which 161,744 patients had CDI (4.3%). Median age at admission was 52 years, with 56.7% females. There was a rising trend of CDI among IBD patients, from 2.9% in 2007 to a peak of 5.4% in 2015 with a decline towards the end of study period at 4.4% in 2018. Mean score for Elixhauser comorbidity index increased from 4.6 to 7.4 (p-trend The median LOS was 4 days for patients without CDI vs 6 days with CDI. Trend in LOS was stable for patients without CDI but decreased from 8 days to 5 days over the 12-year study period for patients with CDI (p-trend The overall mortality among IBD patients was 1.6% with no significant trend observed over time. All cause in-hospital mortality was significantly higher among patients with concomitant CDI (6.8%) vs without CDI (1.4%) (RR 4.99, 95% CI 4.89 - 5.10). Within CDI subgroup, there was a trend of decrease in mortality from 7-11% in the beginning of the study, to about 3-3.5% towards the end of the study period (p-trend After adjusting for inflation, there was a significant increase in charges among both subgroups: increased from $28,575 in 2007 to $68,614 in 2018 (p-trend CONCLUSION The incidence of CDI in IBD patients increased over the study period with stability towards the latter half. Hospitalized IBD patients with concomitant CDI have a higher comorbidity index, a longer length of stay, a higher risk of colectomy and an increased risk of mortality when compared to those without CDI. Total hospitalization charges are also significantly higher with CDI subgroup and have been increasing overtime.