In-House Anesthesia and Interventional Radiology Technologist Support Optimize Mechanical Thrombectomy Workflow after Hours
In-House Anesthesia and Interventional Radiology Technologist Support Optimize Mechanical Thrombectomy Workflow after Hours
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DOI：
10.1016/j.jstrokecerebrovasdis.2020.105246
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发表时间：
2020-11-01
影响因子：
2.5
通讯作者：
Ortega-Gutierrez, Santiago
中科院分区：
文献类型：
--
作者：
Dandapat, Sudeepta;Al Kasab, Sami;Ortega-Gutierrez, Santiago
背景和目的：先前的文献表明，在接受血栓摘除术的中风患者中，下班后的延迟会导致不良的功能结果。我们的目的是评估在配备手术室(OR)的介入放射学(IR)套间中，呈现时间对机械性血栓切除术(MT)指标的影响及其与长期功能结果的相关性。方法：回顾2015年1月至2018年12月在我们CSC接受机械血栓清除术的所有卒中患者的前瞻性数据库。工作时间由正式工作时间(星期一至星期五上午7点和下午5点)和下班时间界定，即工作日和周末以及医院正式节假日的下午5点至上午7点之间。主要结果是90天改良Rankin评分(MRS)。次要结果包括门到腹股沟的穿刺点时间和操作并发症。结果：共有315名患者进入分析。209例(66.4%)在下班后接受机械取栓术，106例(33.6%)在工作时间接受机械取栓术。在90天时MRS上功能结果的转移分布(OR：1.14，CI：0.72~1.78，p=0.58)和90天时患者获得功能独立的百分比(MRS 0~2)在下班后组和工作时间组之间分别没有差异(43.1%比41.3%；p=0.83)。同样，两组间腹股沟至腹股沟时间的中位数和手术并发症没有差异，总体时间指标较上年有显著改善。结论：我们的研究表明，在OR环境中，与在工作时间进行MT相比，在非工作时间进行MT具有相似的功能结果。如果在拥有24小时室内麻醉和IR技术服务的系统中进行MT，那么下班后的有害影响可能会消失。
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.