No abstract

Background: Faster revascularization times are associated with better functional outcome in patients undergoing thrombectomy. We aim to evaluate the impact of time of day presentation on thrombectomy metrics and its association with long-term functional outcome in an IR equipped OR setting. Methods: We retrospective reviewed all stroke patients who received mechanical thrombectomy between December 2012 and December 2017 at our CSC from our prospectively collected database. Work hours were defined by official OR work hours (Monday-Friday 7 AM and 5PM) and after hours as between 5 PM and 7 AM during weekdays and weekends as well as official hospital holidays. Collected data included baseline demographics, admission NIHSS, receipt of tPA, and location of occlusion. Primary outcomes were delta NIHSS between admission and discharge and 90-day modified Rankin Scale (mRS). Secondary outcomes included door to groin time and revascularization rate (TICI2b and 3). Multivariable logistic and Wilcoxon Rank test were performed to compare groups. Results: A total of 78 (38%) patients underwent mechanical thrombectomy during work hours and 125 (62%) during after-hours. There were more females in the after-hours group (55% vs 40%, P=0.046). There was no difference in mean age (66.8 vs 68.1, P=0.457), race (93% whites in both group) and median admission NIHSS (17 in both groups). Median door to groin time was 85 minutes during work hours vs. 94 minutes during after-hours (P=0.93). There was no difference in revascularization rate (70% vs 76%, P=0.67), delta NIHSS (2.9 vs 5.7, P=0.173) or long-term functional outcome (43% vs 53%, P=0.121) between after-hours vs work hours respectively. Conclusion: Studies suggest that after hours delay could impact functional outcomes on stroke patients undergoing thrombectomy. In-house 24/7 Anesthesia and IR tech services might improve metrics and mitigate this effect.