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

Sudeepta Dandapat; Sami Al Kasab; Cynthia B Zevallos; Mudassir Farooqui; Biyue Dai; Darko Quispe-Orozco; Andres Dajles; David Hasan; Edgar A Samaniego; Colin P Derdeyn; Santiago Ortega-Gutierrez

doi:10.1016/j.jstrokecerebrovasdis.2020.105246

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

Journal article

Peer reviewed

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

Sudeepta Dandapat, Sami Al Kasab, Cynthia B Zevallos, Mudassir Farooqui, Biyue Dai, Darko Quispe-Orozco, Andres Dajles, David Hasan, Edgar A Samaniego, Colin P Derdeyn, …

Journal of stroke and cerebrovascular diseases, Vol.29(11), pp.105246-105246

11/2020

DOI: 10.1016/j.jstrokecerebrovasdis.2020.105246

PMID: 33066913

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Abstract

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. 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. 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. 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.

Stroke - diagnostic imaging

Humans

Middle Aged

Male

Stroke - physiopathology

Recovery of Function

Radiography, Interventional - adverse effects

Delivery of Health Care, Integrated - organization & administration

Time Factors

Patient Care Team - organization & administration

Aged, 80 and over

Female

Retrospective Studies

After-Hours Care - organization & administration

Stroke - therapy

Databases, Factual

Disability Evaluation

Operating Rooms - organization & administration

Risk Factors

Operating Room Technicians - organization & administration

Treatment Outcome

Workflow

Thrombectomy - adverse effects

Anesthesia Department, Hospital - organization & administration

Anesthesiologists - organization & administration

Aged

Time-to-Treatment - organization & administration

Details

Title: Subtitle: In-House Anesthesia and Interventional Radiology Technologist Support Optimize Mechanical Thrombectomy Workflow after Hours
Creators: Sudeepta Dandapat - Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, IA
Sami Al Kasab - Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, IA
Cynthia B Zevallos - Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, IA
Mudassir Farooqui - Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, IA
Biyue Dai - Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, IA
Darko Quispe-Orozco - Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, IA
Andres Dajles - Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, IA
David Hasan - Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA
Edgar A Samaniego - Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, IA; Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA
Colin P Derdeyn - Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA
Santiago Ortega-Gutierrez - Department of Neurology, University of Iowa Carver College of Medicine, Comprehensive Stroke Center, Iowa City, IA; Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA; Department of Radiology, University of Iowa Carver College of Medicine, Iowa City, IA. Electronic address: santy-ortega@uiowa.edu
Resource Type: Journal article
Publication Details: Journal of stroke and cerebrovascular diseases, Vol.29(11), pp.105246-105246
DOI: 10.1016/j.jstrokecerebrovasdis.2020.105246
PMID: 33066913
NLM abbreviation: J Stroke Cerebrovasc Dis
ISSN: 1052-3057
eISSN: 1532-8511
Publisher: Elsevier Inc; United States
Language: English
Date published: 11/2020
Academic Unit: Roy J. Carver Department of Biomedical Engineering; Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery; Otolaryngology
Record Identifier: 9984070406602771

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