Introduction Increasing U.S. health care costs and the COVID pandemic put increased pressure on hospitals to reduce the length of stay while maintaining high-quality care and outcomes. Our primary aim was to test the safety and feasibility of a same-day discharge model following elective neuroendovascular procedures.

Materials and Methods A prospectively selected group of patients underwent elective neuroendovascular interventions with a plan for discharge to an on-campus care hotel. Patients have nurse monitoring and immediate access to hospital services if needed. Patients were >18 years of age with a modified Rankin Scale (mRS) score ≤ 3 and were treated between October 2020 and December 2022. Patients with the following criteria were excluded: significant comorbidities, patients without an aid member (family or friend), required hospitalization by the insurer (e.g: carotid artery angioplasty and stenting, international patients), additional care requiring hospitalization, or patient refusal of this model. Patients underwent hourly neurological assessment and were monitored in the Post Anesthesia Care Unit (PACU). After 4 hours, they were assessed by the treating team and transferred to the care hotel with an aid member after meeting hospital discharge criteria. The primary and secondary safety endpoints were evaluated by complications requiring readmission and change in mRS by ≥1 point, respectively.

Results Seventy-eight patients were assessed for this care model and 42 were enrolled. Twenty-nine (69%) were women, and the mean age was 63 years (range 25-84). There were 35 aneurysms: flow diversion (n=19), stent-assisted coiling (n=7), coiling (n=8), and flow diversion with coiling (n=1). The mean aneurysm diameter and neck were 7.3 mm and 4.6 mm, respectively. Other procedures included arteriovenous fistula embolization (n=3), angioplasty and stent for vertebral or subclavian stenosis (n=3), and middle meningeal artery embolization (n=1). Preoperative mRS scores were 0 (n=23), 1 (n=15), 2 (n=3), and 3 (n=1). Two patients (5%) were readmitted overnight for transient numbness after flow diversion for aneurysms. Two patients (5%) were evaluated in the emergency room for oozing at the puncture site and for an episode of shortness of breath, respectively. All patients were discharged home the following day except 1 patient with numbness who stayed for 2 days and MRI showed ipsilateral DWI changes. The average time for the last follow-up was 5 months and mRS scores were 0 (n=25), 1 (n=16), and 2 (n=1). No patient experienced a drop in mRS at the last follow-up. Based on Time-Driven Activity-based Costing (TDABC) for ICU beds, $1,500-2,600 were saved per procedure, totaling $63,000-109,000.

Conclusions This preliminary fast-track model is safe, feasible, and cost-effective for carefully selected patients undergoing elective neuroendovascular interventions. Careful patient selection combined with discharge readiness criteria is essential to minimize readmissions.

Disclosures A. Ghaith: None. W. Freeman: None. S. Kashyap: None. R. Chadha: None. E. Greco: None. E. Bojaxhi: None. C. Perez- Vega: None. W. Fox: None. R. Tawk: None.