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In-House Anesthesia and Interventional Radiology Technologist Support Optimize Mechanical Thrombectomy Workflow after Hours.

Publication ,  Journal Article
Dandapat, S; Kasab, SA; Zevallos, CB; Farooqui, M; Dai, B; Quispe-Orozco, D; Dajles, A; Hasan, D; Samaniego, EA; Derdeyn, CP; Ortega-Gutierrez, S
Published in: J Stroke Cerebrovasc Dis
November 2020

BACKGROUND AND PURPOSE: Prior literature suggests after-hours delay leads to poor functional outcomes in stroke patients undergoing thrombectomy. We aimed to evaluate the impact of time of presentation on mechanical thrombectomy (MT) metrics and its association with long-term functional outcome in an Interventional Radiology (IR) suite equipped operating room (OR) setting. METHODS: Retrospective review of prospectively maintained database on all stroke patients undergoing mechanical thrombectomy between January 2015 and December 2018 at our CSC. Work hours were defined by official OR work hours (Monday-Friday 7 AM and 5 PM) and after-hours as between 5 PM and 7 AM during weekdays and weekends as well as official hospital holidays. Primary outcome was 90-day modified Rankin Scale (mRS). Secondary outcomes included door to groin puncture time and procedural complications. RESULTS: A total of 315 patients were included in the analyses. 209 (66.4%) received mechanical thrombectomy after hours and 106 (33.6%) during work hours. There was no difference in the shift distribution of functional outcome on the mRS at 90 days (OR: 1.14, CI: 0.72-1.78, p=0.58) and the percentage of patients achieving functional independence (mRS 0-2) at 90 days (43.1% vs. 41.3%; p=0.83) between the after hour and work hour groups respectively. Similarly, there was no difference in median door to groin times and procedural complications among both groups, with significant year on year improvement in overall time metrics. CONCLUSIONS: Our study showed that undergoing MT during off-hours had similar functional outcomes when compared to MT during working hours in an OR setting. The after-hours deleterious effect might disappear when MT is performed in a system with 24-hours in-house Anesthesia and IR tech services.

Duke Scholars

Published In

J Stroke Cerebrovasc Dis

DOI

EISSN

1532-8511

Publication Date

November 2020

Volume

29

Issue

11

Start / End Page

105246

Location

United States

Related Subject Headings

  • Workflow
  • Treatment Outcome
  • Time-to-Treatment
  • Time Factors
  • Thrombectomy
  • Stroke
  • Risk Factors
  • Retrospective Studies
  • Recovery of Function
  • Radiography, Interventional
 

Citation

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Dandapat, S., Kasab, S. A., Zevallos, C. B., Farooqui, M., Dai, B., Quispe-Orozco, D., … Ortega-Gutierrez, S. (2020). In-House Anesthesia and Interventional Radiology Technologist Support Optimize Mechanical Thrombectomy Workflow after Hours. J Stroke Cerebrovasc Dis, 29(11), 105246. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105246
Dandapat, Sudeepta, Sami Al Kasab, Cynthia B. Zevallos, Mudassir Farooqui, Biyue Dai, Darko Quispe-Orozco, Andres Dajles, et al. “In-House Anesthesia and Interventional Radiology Technologist Support Optimize Mechanical Thrombectomy Workflow after Hours.J Stroke Cerebrovasc Dis 29, no. 11 (November 2020): 105246. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105246.
Dandapat S, Kasab SA, Zevallos CB, Farooqui M, Dai B, Quispe-Orozco D, et al. In-House Anesthesia and Interventional Radiology Technologist Support Optimize Mechanical Thrombectomy Workflow after Hours. J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105246.
Dandapat, Sudeepta, et al. “In-House Anesthesia and Interventional Radiology Technologist Support Optimize Mechanical Thrombectomy Workflow after Hours.J Stroke Cerebrovasc Dis, vol. 29, no. 11, Nov. 2020, p. 105246. Pubmed, doi:10.1016/j.jstrokecerebrovasdis.2020.105246.
Dandapat S, Kasab SA, Zevallos CB, Farooqui M, Dai B, Quispe-Orozco D, Dajles A, Hasan D, Samaniego EA, Derdeyn CP, Ortega-Gutierrez S. In-House Anesthesia and Interventional Radiology Technologist Support Optimize Mechanical Thrombectomy Workflow after Hours. J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105246.
Journal cover image

Published In

J Stroke Cerebrovasc Dis

DOI

EISSN

1532-8511

Publication Date

November 2020

Volume

29

Issue

11

Start / End Page

105246

Location

United States

Related Subject Headings

  • Workflow
  • Treatment Outcome
  • Time-to-Treatment
  • Time Factors
  • Thrombectomy
  • Stroke
  • Risk Factors
  • Retrospective Studies
  • Recovery of Function
  • Radiography, Interventional