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Regional Differences in Thrombectomy Rates

Secondary use of Billing Codes in the MIRACUM (Medical Informatics for Research and Care in University Medicine) Consortium

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Abstract

Background and Purpose

Mechanical thrombectomy, in addition to intravenous (i.v.) thrombolysis is recommended for treatment of acute stroke in patients with large vessel occlusions (LVO) in the anterior circulation up to 6 h after symptom onset. We compared thrombectomy rates of eight university hospitals of the MIRACUM consortium to analyze the implementation of this guideline in clinical routine.

Methods

Anonymized billing data in a standardized format were loaded into a local i2b2 data warehouse by applying already existing extract, transform and load (ETL) routines. A locally executed uniform SQL (structured query language) query delivered aggregated site data for all inpatients with a discharge diagnosis of ischemic stroke (ICD-10 I63) containing counts for type of acute treatment, type of admission and age groups, which were centrally analyzed with R.

Results

From 2014 to 2016, the thrombectomy rate almost doubled from a mean of 4.7% to 9.6%, although significant differences between centers exist (range in 2016: 5.8–17%). The number of drip-and-ship procedures increased in 3 out of 8 centers. There was no evidence for a decrease in thrombectomy rates during weekends/holiday or among patients older than 80 years, but this age group is more likely to receive i.v. recombinant tissue plasminogen activator (rtPA).

Conclusion

The observed increase of thrombectomy rates and drip-and-ship procedures without a significant difference between weekdays and weekends or patients of different ages is substantiating a rapid implementation of stroke guidelines within the analyzed neurovascular centers. The prototype of the MIRACUM Data Integration Center already contributes to health services research in Germany.

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Acknowledgements

MIRACUM is funded by the German Federal Ministry of Education and Research (BMBF) within the “Medical Informatics Funding Scheme” (FKZ 01ZZ1606H).

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Authors and Affiliations

  1. Staff Unit IT-Processes, Faculty of Medicine and Medical Center, University of Freiburg, Agnesenstr. 6–8, 79106, Freiburg, Germany

    Christian Haverkamp

  2. Center of Medical Information and Communication Technology, University Hospital Erlangen, Glückstraße 11, 91054, Erlangen, Germany

    Thomas Ganslandt

  3. Center for Medical Biometry and Medical Informatics, Faculty of Medicine and Medical Center, University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany

    Petar Horki & Martin Boeker

  4. Department of Neuroradiology, University Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Arnd Dörfler

  5. Department of Neurology, University Erlangen-Nürnberg, Schwabachanlage 6, 91054, Erlangen, Germany

    Stefan Schwab

  6. Institute of Neuroradiology, Johann Wolfgang Goethe–University, Schleusenweg 2–16, Haus 95, 60528, Frankfurt, Germany

    Joachim Berkefeld

  7. Department of Neurology, Frankfurt University Hospital, Schleusenweg 2–16, Haus 95, 60528, Frankfurt, Germany

    Waltraud Pfeilschifter

  8. Department of Neurology, Medical Center, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany

    Wolf-Dirk Niesen

  9. Department of Neuroradiology, Medical Center, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany

    Karl Egger & Horst Urbach

  10. Department of Neurology, Justus-Liebig-University Giessen, Klinikstraße 33, 35385, Giessen, Germany

    Manfred Kaps

  11. Department of Neuroradiology, University Medical Center Mainz, Langenbeckstr. 1, 55101, Mainz, Germany

    Marc A. Brockmann

  12. Department of Neuroradiology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Germany

    Eva Neumaier-Probst

  13. Department of Neurology, University Medical Center Mannheim, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Germany

    Kristina Szabo

  14. Institute of Neuroradiology, Otto von Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany

    Martin Skalej

  15. Department of Neuroradiology, Philipps-University Marburg, Baldingerstr. 1, 35043, Marburg, Germany

    Siegfried Bien

  16. Department of Neurology, Philipps-University Marburg, Baldingerstr. 1, 35043, Marburg, Germany

    Christoph Best

  17. Chair of Medical Informatics, Friedrich-Alexander-University Erlangen-Nürnberg, Wetterkreuz 13, 91058, Erlangen-Tennenlohe, Germany

    Hans-Ulrich Prokosch

Authors
  1. Christian Haverkamp
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  2. Thomas Ganslandt
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  3. Petar Horki
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  4. Martin Boeker
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  5. Arnd Dörfler
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  6. Stefan Schwab
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  7. Joachim Berkefeld
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  8. Waltraud Pfeilschifter
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  9. Wolf-Dirk Niesen
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  10. Karl Egger
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  11. Manfred Kaps
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  12. Marc A. Brockmann
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  13. Eva Neumaier-Probst
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  14. Kristina Szabo
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  15. Martin Skalej
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  16. Siegfried Bien
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  17. Christoph Best
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  18. Hans-Ulrich Prokosch
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  19. Horst Urbach
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Corresponding author

Correspondence to Christian Haverkamp.

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Conflict of interest

H. Urbach received honoraria from Stryker. Between July 2014 and July 2017 C. Best received payments as a consultant for Bayer. W. Pfeilschifter received research funding from Stryker Neurovascular for a project of team-based acute stroke workflow optimization. C. Haverkamp, T. Ganslandt, P. Horki, M. Boeker¸ A. Dörfler, S. Schwab, J. Berkefeld, W.-D. Niesen, K. Egger, M. Kaps, M.A. Brockmann, E. Neumaier-Probst, K. Szabo, M. Skalej, S. Bien, H.-U. Prokosch declare that they have no competing interests.

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Haverkamp, C., Ganslandt, T., Horki, P. et al. Regional Differences in Thrombectomy Rates. Clin Neuroradiol 28, 225–234 (2018). https://doi.org/10.1007/s00062-017-0656-y

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