Abstract Body (Do not enter title and authors here): Background
Same-day discharge (SDD) protocols are increasingly adopted in structural heart interventions due to their potential to reduce hospital length of stay and associated clinical and economic burdens. This meta-analysis evaluates the safety of SDD compared to overnight hospitalization (>24 hours) following percutaneous left atrial appendage closure (LAAC).
Methods
We systematically searched PubMed, Scopus, Web of Science, Embase, and the Cochrane Library from inception through April 2025 for studies comparing SDD and non-SDD protocols in patients undergoing LAAC. The primary outcome was a composite of major complications (death, stroke, and major bleeding) through final follow-up. Secondary outcomes included individual components of the composite, readmission, pericardial effusion, device-related thrombosis, and peridevice leak. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using RevMan software, with p-values <0.05 considered statistically significant.
Results
Seven observational studies (SDD: n=1,590; mean age 76.8 years; 38.8% female; non-SDD: n=55,192; mean age 76.6 years; 42.3% female) were included. The risk of major complications was not significantly different between groups (RR 0.72, 95% CI 0.52–1.00, p=0.05). No significant differences were observed in individual outcomes including death (RR 0.81, p=0.52), stroke (RR 0.39, p=0.16), and major bleeding (RR 0.85, p=0.44). SDD was also comparable in terms of readmission (RR 1.02, p=0.87), device-related thrombosis (RR 1.86, p=0.57), pericardial effusion (RR 0.22, p=0.08), and peridevice leak (RR 0.70, p=0.35).
Conclusions
Despite the observational nature of included studies and potential for selection bias, same-day discharge appears non-inferior to extended hospitalization in terms of safety following LAAC. These findings support the feasibility of SDD protocols and underscore the need for prospective randomized trials in well-selected patient populations.