Same-day discharge safe, feasible for patients undergoing transarterial chemoembolization procedures
New research shows that patients undergoing transarterial chemoembolization (TACE) can safely forego dayslong hospital stays with no negative consequences.
TACE represents a noninvasive treatment for liver cancer, delivering chemotherapy and embolizing agents into the blood vessels that supply tumors. Although it is often considered a standard first line of treatment, not all providers are on the same page when it comes to post-procedural care.
“Transarterial chemoembolization is a well-recognized therapeutic option for patients with multifocal, unresectable hepatocellular carcinoma,” Russ Guidry, from the Section of Interventional Radiology at UAB Heersink School of Medicine in Birmingham, Alabama, and colleagues noted in the journal Clinical Imaging. “Despite its widespread use over the past several decades, the optimal post-procedural regiment for patients after TACE has yet to be determined. For example, some operators prefer to routinely admit patients to the hospital after TACE, with length of stays as long as 4-7 days reported in the literature.”
Guidry and colleagues sought to determine whether hospital admission improved outcomes following TACE. To do this, the team retrospectively compared readmission rates for 348 patients who had undergone either TACE or bland embolization (TAE) for HCC at their institution between January 2019 and June 2022. Adverse events, 30-day readmissions and 30-day mortality were compared between those who were released same-day and those who were admitted overnight.
Of all the cases studied, 69% were discharged the same day, while 31% were kept overnight for observation. In the group of patients who stayed overnight, 28% of the admissions were unplanned, with 30% of those stays owed to procedural complications and another 52% kept due to symptoms of pain, nausea/vomiting, or post-op hyperglycemia.
There were 30 major adverse events among the entire group. These ranged from postembolization syndrome (5) to cirrhotic decompensation (5), hypoxia secondary to pulmonary edema (2), pancreatic necrosis (1) and spontaneous bacterial peritonitis. Of the major adverse events, just five occurred in the same-day discharge group, while 14 were in the hospitalized cohort.
In terms of readmission rates, the research team did not observe a significant difference between the two groups. The data collected did not indicate increased risk of 30-day readmission or mortality for patients allowed to return home the day of their procedure, signaling that patients at average risk prior to TACE are likely candidates for same-day discharge.
The team also was able to identify factors that increased the likelihood of adverse events.
“Our baseline characteristics between the two cohorts show that certain patient and procedural characteristics lend to a possible increased likelihood of observation overnight rather than [same-day discharge]. Such characteristics include higher BCLC Stage, higher ECOG performance status, disease etiology (viral hepatitis more prevalent in overnight observation cohort), use of general anesthesia, higher patient reported pain level post-procedure, and procedural complications,” the authors noted.
The team suggested their findings highlight the safety and feasibility of same-day discharge following TACE—a move that would save time, resources and money for both hospitals and patients. They believe their results could pave the way for improved protocols in the future but also acknowledged that prospective studies are needed to validate their work.
Learn more about the findings here.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.