Study Presented at SNIS Evaluates Timing and Call Burden of Mechanical Thrombectomies at Stroke Centers
July 24, 2017—The Society of NeuroInterventional Surgery (SNIS) announced findings from a study showing that stroke centers average mechanical thrombectomies once every 5 days with approximately 60% of the procedures occurring during nonwork hours. As the first study to examine the times at which mechanical thrombectomies occur and the call burden on neurointerventional staff, these findings could have implications for physician staffing at stroke centers and the patients receiving treatment, noted SNIS.
The study, "A Multicenter Study Evaluating the Frequency and Burden of Mechanical Thrombectomy on Stroke Centers," was presented at the SNIS 14th annual meeting in Colorado Springs, Colorado.
The study's lead author is Kyle Fargen, MD, MPH, assistant professor of neurological surgery at Wake Forest University in Winston-Salem, North Carolina. As background for the study, Dr. Fargen noted the lack of published data regarding time of day in relation to stroke presentations.
The retrospective study collected data from 10 stroke centers during a 3-month period in 2016; eight of the 10 participating centers were comprehensive stroke centers. In that period, 189 patients with emergent large vessel occlusion (ELVO) underwent emergent angiography with the intent to have a mechanical thrombectomy at participating centers. During that time, the peak period when most procedures were started was between 8 PM to 11 PM, with the highest 1-hour concentration falling between 8 PM and 9 PM. The average number of procedures per hospital was 18.9. The median procedural time was 57 minutes and the overall physician time for each patient was approximately 2.5 hours, although this metric did not include postprocedure responsibilities. The study did not find any differences in the frequency of the procedure based on the day of the week, or of the procedure’s length based on the time of day it was performed.
However, the total time from intake to conclusion was longer in cases beginning after work hours. Dr. Fargen emphasized the need to recognize the possible reasons for delays to the start of procedures after hours and identify solutions. SNIS President Don Frei, MD, agreed, noting the decline in optimal outcomes the longer it takes to remove the clot.
"As awareness increases of the benefits of mechanical thrombectomy for ELVO, it’s vital that we understand the frequency and the times at which these procedures occur so that we can optimize outcomes for our patients,” commented Dr. Fargen in the SNIS announcement.
A separate prospective evaluation of the time burden of thrombectomy on neurointerventional physicians is underway. The study includes telephone consultations and work taking place after groin closure, said Dr. Fargen.