What is the typical length of hospital stay after stent placement?

Length of Hospital Stay After Coronary Stent Placement

Most patients can be safely discharged within 24 hours after uncomplicated coronary stent placement, with same-day discharge being feasible in carefully selected patients.

Factors Affecting Length of Stay

The typical hospital stay after coronary stent placement depends on several key factors:

Type of Stent

• Bare Metal Stent (BMS):

  • Generally requires shorter hospital stay
  • Often allows for same-day or next-day discharge in uncomplicated cases 1

• Drug-Eluting Stent (DES):

  • Similar to BMS for hospital stay duration
  • Requires longer duration of dual antiplatelet therapy (DAPT) after discharge

Clinical Presentation

• Elective/Stable Coronary Disease:

  • Shorter hospital stay (typically 24 hours or less)
  • Same-day discharge possible in selected patients 1

• Acute Coronary Syndrome (ACS):

  • Longer observation period typically required (24-48 hours)
  • Additional monitoring for complications

Procedural Factors

• Access Site:

  • Radial approach facilitates earlier ambulation and discharge 1
  • Femoral approach may require longer bed rest

• Procedural Complications:

  • Uncomplicated procedures: shorter stay
  • Complications (bleeding, vascular issues, procedural complications): extended stay

Discharge Timeline

Same-Day Discharge

• Feasible in carefully selected patients with:
  • Uncomplicated procedure
  • Stable clinical status
  • Radial access
  • Adequate social support at home 1

Next-Day Discharge

• Standard approach for most uncomplicated cases
• Allows for:
  • Post-procedure monitoring
  • Medication education
  • Arrangement of follow-up care

Extended Stay (>24 hours)

• Indicated for:
  • Procedural complications
  • Hemodynamic instability
  • High-risk clinical features
  • Inadequate social support

Post-Discharge Medication Management

After discharge, patients require careful medication management:

• Aspirin: Continue indefinitely 2, 3

  • Initial dose: 81-325 mg daily for at least 1 month after BMS, 3 months after sirolimus-eluting stent, 6 months after paclitaxel-eluting stent
  • Maintenance dose: 81 mg daily (preferred) 2, 3

• P2Y12 Inhibitor (clopidogrel, prasugrel, or ticagrelor):

  • ACS patients: At least 12 months 2
  • Non-ACS with DES: At least 12 months 2
  • Non-ACS with BMS: Minimum 1 month, ideally up to 12 months 2

Common Pitfalls to Avoid

1. Premature discontinuation of antiplatelet therapy

   • Increases risk of stent thrombosis
   • Patients should be explicitly instructed not to stop therapy without consulting their cardiologist 2

2. Inadequate patient education before discharge

   • Patients need clear instructions about:
     • Medication regimen
     • Activity restrictions
     • Signs/symptoms requiring medical attention
     • Follow-up appointments

3. Failure to coordinate post-discharge care

   • Ensure timely follow-up with cardiologist
   • Communicate with primary care provider

4. Scheduling non-cardiac surgery too soon after stent placement

   • Elective non-cardiac surgery should be delayed:
     • At least 30 days after BMS 2
     • At least 6 months after DES 2
   • If surgery is needed earlier, maintain aspirin if possible 2

Special Considerations

High Bleeding Risk Patients

• Lower-dose aspirin (75-81 mg) is reasonable during the initial period 2
• Earlier discontinuation of P2Y12 inhibitor therapy (<12 months) may be considered if bleeding risk outweighs benefit 2

Elderly Patients

• May require longer observation period
• Careful assessment of social support before discharge

Complex Procedures

• Multiple stents or complex anatomy may warrant longer observation

In conclusion, while same-day discharge is increasingly common and safe for selected patients after uncomplicated coronary stent placement, most patients are discharged within 24 hours. The focus should be on ensuring medication compliance, adequate patient education, and appropriate follow-up rather than extending the hospital stay unnecessarily.