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Ghozy S, Hasanzadeh A, Kobeissi H, Abdelghaffar M, Shafie M, Beizavi Z, Hassankhani A, Azzam AY, Dmytriw AA, Kadirvel R, Kallmes DF. The impact of off-hour mechanical thrombectomy therapy on outcomes for acute ischemic stroke: A systematic review and meta-analysis. J Neurol Sci 2023; 453:120802. [PMID: 37741122 DOI: 10.1016/j.jns.2023.120802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND The impact of off-hours and on-hours mechanical thrombectomy (MT) treatment for acute ischemic stroke (AIS) is not well understood. We conducted a systematic review and met-analysis comparing outcomes between patients undergoing off-hours MT versus on-hours MT. METHODS This study is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses recommendations. A systematic literature review of the English language literature was conducted using Web of Science, Embase, Scopus, and PubMed databases. We included all original studies comparing off-hour and on-hour outcomes or time metrics in AIS undergoing MT. R software version 4.3.1 and the 'meta' statistical package were used to analyze all the data presented in this study. RESULTS We included 26 studies with 82,850 patients. Patients undergoing MT during off-hours achieved lower rates of 90-day functional independence (OR 0.92, 95% CI 0.86-0.99; p = 0.04) and successful recanalization (OR 0.89, 95% CI 0.81-0.98; p = 0.014). Patients undergoing off-hours MT experienced similar rates of 90-day mortality (OR 1.07, 95% CI 0.96-1.19; p = 0.21) and sICH (OR 1.04, 95% CI 0.85-1.28; p = 0.674). Patients in the off-hour group experienced longer onset to door time (MD = 12.23 min; 95% CI 4.53-19.93; p = 0.002), imaging to puncture time (MD = 10.59 min; 95% CI 4.00-17.19; p = 0.002), and door to recanalization time (MD = 13.31 min; 95% CI 4.60-22.03; p = 0.003). CONCLUSIONS Patients undergoing MT for AIS during off-hours experienced lower rates of functional independence. This may be attributed to treatment delays during off-hours. Future studies should work to optimize hospital workflows and identify factors which may contribute to treatment delays.
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Affiliation(s)
- Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
| | | | - Hassan Kobeissi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; College of Medicine, Central Michigan University, Mount Pleasant, MI, USA
| | | | - Mahan Shafie
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Zahra Beizavi
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Amir Hassankhani
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA, USA
| | - Ahmed Y Azzam
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Adam A Dmytriw
- Neuroendovascular Program, Massachusetts General Hospital, Harvard University, Boston, MA, USA; Neurovascular Centre, Departments of Medical Imaging and Neurosurgery, St. Michael's Hospital, Toronto, ON, Canada
| | - Ramanathan Kadirvel
- Department of Radiology, Mayo Clinic, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
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Taylor BS, Patel S, Hilden P, Otite F, Lee K, Gupta G, Khandelwal P. The weekend effect on mechanical thrombectomy: A nationwide analysis before and after the pivotal 2015 trials. Brain Circ 2022; 8:137-145. [PMID: 36267433 PMCID: PMC9578310 DOI: 10.4103/bc.bc_23_22] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 06/08/2022] [Accepted: 06/09/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES: MATERIALS AND METHODS: RESULTS: CONCLUSIONS:
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Grandhi R, Ravindra VM, Ney JP, Zaidat O, Taussky P, de Havenon A. Investigating the "Weekend Effect" on Outcomes of Patients Undergoing Endovascular Mechanical Thrombectomy for Ischemic Stroke. J Stroke Cerebrovasc Dis 2021; 30:106013. [PMID: 34375859 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES With growing evidence of its efficacy for patients with large-vessel occlusion (LVO) ischemic stroke, the use of endovascular thrombectomy (EVT) has increased. The "weekend effect," whereby patients presenting during weekends/off hours have worse clinical outcomes than those presenting during normal working hours, is a critical area of study in acute ischemic stroke (AIS). Our objective was to evaluate whether a "weekend effect" exists in patients undergoing EVT. METHODS This retrospective, cross-sectional analysis of the 2016-2018 Nationwide Inpatient Sample data included patients ≥18 years with documented diagnosis of ischemic stroke (ICD-10 codes I63, I64, and H34.1), procedural code for EVT, and National Institutes of Health Stroke Scale (NIHSS) score; the exposure variable was weekend vs. weekday treatment. The primary outcome was in-hospital death; secondary outcomes were favorable discharge, extended hospital stay (LOS), and cost. Logistic regression models were constructed to determine predictors for outcomes. RESULTS We identified 6052 AIS patients who received EVT (mean age 68.7±14.8 years; 50.8% female; 70.8% White; median (IQR) admission NIHSS 16 (10-21). The primary outcome of in-hospital death occurred in 560 (11.1%); the secondary outcome of favorable discharge occurred in 1039 (20.6%). The mean LOS was 7.8±8.6 days. There were no significant differences in the outcomes or cost based on admission timing. In the mixed-effects models, we found no effect of weekend vs. weekday admission on in-hospital death, favorable discharge, or extended LOS. CONCLUSION These results demonstrate that the "weekend effect" does not impact outcomes or cost for patients who undergo EVT for LVO.
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Affiliation(s)
- Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT 84132, USA.
| | - Vijay M Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT 84132, USA; Department of Neurosurgery, Naval Medical Center San Diego, 34800 Bob Wilson Dr., San Diego, CA 92134, USA.
| | - John P Ney
- Department of Neurology, Boston University, 72 East Concord Street, C-3, MA 02118, USA.
| | - Osama Zaidat
- Department of Neurology, Mercy Health, 2222 Cherry St m200, Toledo, OH 43608, USA.
| | - Philipp Taussky
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT 84132, USA.
| | - Adam de Havenon
- Department of Neurology, Clinical Neurosciences Center, University of Utah, 175 N. Medical Drive East, Salt Lake City, UT 84132, USA.
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Zha M, Yang Q, Liu S, Huang K, Zhang X, Wu M, Cai H, Lv Q, Liu R, Yang D, Liu X. Off-hour effect is not significant in endovascular treatment for anterior circulation large vessel occlusion in a multicentre registry. Stroke Vasc Neurol 2021; 6:640-648. [PMID: 34244447 PMCID: PMC8717780 DOI: 10.1136/svn-2021-000949] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022] Open
Abstract
Background and purpose Whether the off-hour effect has an impact on workflow and outcomes of endovascular treatment (EVT) for anterior circulation large vessel occlusion (AC-LVO) remains uncertain. This study aimed to compare the characteristics and outcomes of patients who presented or were treated during off-hour versus on-hour in a multi-center registry. Methods AC-LVO patients from 21 centres were categorised into the off-hour group and the on-hour group. Off-hour (weekends, holidays, and 18:00–7:59 on weekdays) and on-hour (8:00–17:59 on weekdays except for holidays) were defined according to arrival and groin-puncture time points, respectively. Subgroup comparisons between patients both arrived and treated during off-hour (true off-hour) and on-hour (true on-hour) were performed. The primary outcome was the 90-day modified Rankin Scale (mRS) score. Secondary outcomes included favourable outcome (mRS 0–2 at 90 days), EVT-related time metrics, and other clinical outcomes. Ordinary and binary logistic regression and linear regression were taken to adjust for confounding factors. Results Of all 698 patients enrolled, 435 (62.3%) and 456 (65.3%) patients were categorised into the off-hour arrival and off-hour puncture group, respectively. Shorter onset to door time (adjusted ß coefficient: −21.56; 95% CI −39.96 to −3.16; p=0.022) was noted in the off-hour arrival group. Ordinal and dichotomous mRS scores at 90 days were comparable between the off-hour group and the on-hour group regardless of off-hour definitions. Other time metrics and outcomes were comparable between the two groups. Of 595 patients both presented and were treated during off-hour or on-hour, 394 patients were categorised into the true off-hour group and 201 into the true on-hour group. Time metrics and clinical outcomes were similar between the true off-hour and the true on-hour group. Conclusions The off-hour effect was not significant regarding clinical outcomes and in-hospital workflow in AC-LVO patients receiving EVT in this Chinese multicentre registry.
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Affiliation(s)
- Mingming Zha
- Department of Neurology, Southeast University, Nanjing, Jiangsu, China
| | - Qingwen Yang
- Department of Neurology, Southeast University, Nanjing, Jiangsu, China
| | - Shuo Liu
- Department of Internal Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Kangmo Huang
- Department of Neurology, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Xiaohao Zhang
- Department of Neurology, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Min Wu
- Department of Neurology, Southern Medical University, Guangzhou, Guangdong, China
| | - Haodi Cai
- Department of Neurology, Southeast University, Nanjing, Jiangsu, China
| | - Qiushi Lv
- Department of Neurology, Nanjing Jinling Hospital, Nanjing, Jiangsu, China
| | - Rui Liu
- Department of Neurology, Nanjing Jinling Hospital, Nanjing, Jiangsu, China
| | - Dong Yang
- Department of Neurology, Nanjing Jinling Hospital, Nanjing, Jiangsu, China
| | - Xinfeng Liu
- Department of Neurology, Southeast University, Nanjing, Jiangsu, China .,Department of Neurology, Nanjing Jinling Hospital, Nanjing, Jiangsu, China
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Zha M, Yang Q, Liu S, Wu M, Huang K, Cai H, Zhang X, Lv Q, Liu R, Yang D, Liu X. Off-hour effect on time metrics and clinical outcomes in endovascular treatment for large vessel occlusion: A systematic review and meta-analysis. Int J Stroke 2021; 17:669-680. [PMID: 33877016 DOI: 10.1177/17474930211012545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is an ongoing debate on the off-hour effect on endovascular treatment (EVT) for acute large vessel occlusion (LVO). AIM This meta-analysis aimed to compare time metrics and clinical outcomes of acute LVO patients who presented/were treated during off-hour with those during working hours. SUMMARY OF REVIEW Structured searches on the PubMed, Embase, Web of Science, and Cochrane Library databases were conducted through 23 February 2021. The primary outcomes were onset to door (OTD), door to imaging, door to puncture (DTP), puncture to recanalization, procedural time, successful recanalization, symptomatic intracranial hemorrhage (SICH), mortality in hospital, good prognosis (90-day modified Rankin Scale (mRS) score 0-2), and 90-day mortality. The secondary outcomes were imaging to puncture (ITP), onset to puncture (OTP), onset to recanalization (OTR), door to recanalization (DTR) time, mRS 0-2 at discharge, and consecutive 90-day mRS score. The odds ratio (OR) and weighted mean difference (WMD) with 95% confidence interval (CI) of the outcomes were calculated using random-effect models. Heterogenicity and publication bias were analyzed. Subgroup and sensitivity analyses were conducted as appropriate. Nineteen studies published between 2014 and 2021 with a total of 14,185 patients were eligible for quantitative synthesis. Patients in the off-hour group were significantly younger than those in the on-hour group and with comparable stroke severity and intravenous thrombolysis rate. The off-hour group had longer OTD (WMD [95% CI], 12.83 [1.84-23.82] min), DTP (WMD [95% CI], 11.45 [5.93-16.97] min), ITP (WMD [95% CI], 10.39 [4.61-16.17] min), OTP (WMD [95% CI], 25.30 [13.11-37.50] min), OTR (WMD [95% CI], 25.16 [10.28-40.04] min), and DTR (WMD [95% CI], 18.02 [10.01-26.03] min) time. Significantly lower successful recanalization rate (OR [95% CI], 0.85 [0.76-0.95]; p = 0.004; I2 = 0%) was detected in the off-hour group. No significant difference was noted regarding SICH and prognosis. But a trend toward lower OR of good prognosis was witnessed in the off-hour group (OR [95% CI], 0.92 [0.84-1.01]; p = 0.084; I2 = 0%). CONCLUSIONS Patients who presented/were treated during off-hour were associated with excessive delays before the initiation of EVT, lower successful reperfusion rate, and a trend toward worse prognosis when compared with working hours. Optimizing the workflows of EVT during off-hour is needed.
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Affiliation(s)
- Mingming Zha
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Qingwen Yang
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Shuo Liu
- Department of Internal Medicine, Medical School of Southeast University, Nanjing, China
| | - Min Wu
- Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China
| | - Kangmo Huang
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, China
| | - Haodi Cai
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China
| | - Xiaohao Zhang
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, China
| | - Qiushi Lv
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, China
| | - Rui Liu
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, China
| | - Dong Yang
- Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, China
| | - Xinfeng Liu
- Department of Neurology, Jinling Hospital, Medical School of Southeast University, Nanjing, China.,Department of Neurology, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.,Department of Neurology, Jinling Hospital, Affiliated Medical School of Nanjing University, Nanjing, China
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Analyzing the effect of weekend and July admission on patient outcomes following non-pyogenic intracranial venous thrombosis. INTERDISCIPLINARY NEUROSURGERY 2020. [DOI: 10.1016/j.inat.2020.100797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Kaaouana O, Bricout N, Casolla B, Caparros F, Schiava LD, Mounier-Vehier F, Pasi M, Dequatre-Ponchelle N, Pruvo JP, Cordonnier C, Hénon H, Leys D. Mechanical thrombectomy for ischaemic stroke in the anterior circulation: off-hours effect. J Neurol 2020; 267:2910-2916. [DOI: 10.1007/s00415-020-09946-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 10/24/2022]
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