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Impacts of in-hospital workflow on functional outcome in stroke patients treated with endovascular thrombectomy

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Abstract

High-performance in-hospital workflow may save time and improve the efficacy of thrombectomy in patients with acute ischemic stroke. However, the optimal in-hospital workflow is far from being formulated, and the current models varied distinctly among centers. This study aimed to evaluate the impacts of in-hospital workflow on functional outcomes after thrombectomy. Patients were enrolled from a multi-center registry program in China. Based on in-hospital managing procedure and personnel involved, two workflow models, neurologist-dominant and non-neurologist-dominant, were identified in the participating centers. Favorable outcome was defined as a mRS score of ≤ 2 at 90 days of stroke onset. After patients being matched with propensity score matching (PSM) method, ratios of favorable outcomes and symptomatic intracerebral hemorrhage (sICH) were compared between patients with different workflow models. Of the 632 enrolled patients, 543 (85.9%) were treated with neurologist-dominant and 89 (14.1%) with non-neurologist-dominant model. 88 patients with neurologist-dominant model and 88 patients with non-neurologist-dominant model were matched with PSM. For the matched patients, no significant differences concerning the ratios of successful recanalization (92.0% vs 87.5%, P = 0.45), sICH (17.0% vs 14.8%, P = 0.85), favorable outcome (42.0% vs 42.0%, P = 1.00) were detected between patients with neurologist-dominant model and those with non-neurologist-dominant model. Patients with neurologist-dominant model had shorter door to puncture time (124 (86–172) vs 156 (120–215), P = 0.005), fewer passes of retriever (2 (1–3) vs 2 (1–4), P = 0.04), lower rate of > 3 passes (11.4% vs 28.4%, P = 0.004), and lower incidence of asymptomatic intracerebral hemorrhage rate (27.3% vs 43.2%, P = 0.045). Although the neurologist-dominant model may decrease in-hospital delay and risk of asymptomatic intracerebral hemorrhage, workflow models may not influence the functional outcome significantly after thrombectomy in patients with acute ischemic stroke.

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Funding

This project was supported by the National Natural Science Foundation of China (Nos. 81530038, 81220108008 and 81671172) and the Jiangsu Provincial Special Program of Medical Science (No. BL2013025).

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  1. Dong Yang and Wenjie Zi contributed equally to this work.

Authors and Affiliations

  1. Department of Neurology, Jinling Hospital, Medical School of Nanjing University, 305 East Zhongshan Road, Nanjing, 210002, Jiangsu, China

    Dong Yang, Huaiming Wang, Yunyun Xiong, Gelin Xu & Xinfeng Liu

  2. Department of Neurology, Xinqiao Hospital and the Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400037, China

    Wenjie Zi

  3. Department of Neurology, The 89th Hospital of People’s Liberation Army, Weifang, 261021, Shandong, China

    Huaiming Wang

  4. Department of Neurology, Sir Run Run Shaw Hospital, Medical School of Zhejiang University, Hangzhou, 310016, Zhejiang, China

    Yonggang Hao

  5. Department of Neurology, Yijishan Hospital of Wannan Medical College, Wuhu, 241004, Anhui, China

    Zhiming Zhou

  6. Department of Neurology, The 900th Hospital of People’s Liberation Army (Fuzhou General Hospital of Nanjing Military Region), Fuzhou, 350025, Fujian, China

    Min Lin

  7. Department of Neurology, Research Institute of Surgery, Daping Hospital and the Third Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400000, China

    Meng Zhang

  8. Division of Life Sciences and Medicine, Stroke Center & Department of Neurology, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230000, Anhui, China

    Xinfeng Liu

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Yang, D., Zi, W., Wang, H. et al. Impacts of in-hospital workflow on functional outcome in stroke patients treated with endovascular thrombectomy. J Thromb Thrombolysis 51, 203–211 (2021). https://doi.org/10.1007/s11239-020-02178-5

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