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Clinical Neuroradiology
Published in: Clinical Neuroradiology 2/2018

01-06-2018 | Original Article

Regional Differences in Thrombectomy Rates

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

Authors: Christian Haverkamp, Thomas Ganslandt, Petar Horki, Martin Boeker, Arnd Dörfler, Stefan Schwab, Joachim Berkefeld, Waltraud Pfeilschifter, Wolf-Dirk Niesen, Karl Egger, Manfred Kaps, Marc A. Brockmann, Eva Neumaier-Probst, Kristina Szabo, Martin Skalej, Siegfried Bien, Christoph Best, Hans-Ulrich Prokosch, Horst Urbach

Published in: Clinical Neuroradiology | Issue 2/2018

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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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Metadata
Title
Regional Differences in Thrombectomy Rates
Secondary use of Billing Codes in the MIRACUM (Medical Informatics for Research and Care in University Medicine) Consortium
Authors
Christian Haverkamp
Thomas Ganslandt
Petar Horki
Martin Boeker
Arnd Dörfler
Stefan Schwab
Joachim Berkefeld
Waltraud Pfeilschifter
Wolf-Dirk Niesen
Karl Egger
Manfred Kaps
Marc A. Brockmann
Eva Neumaier-Probst
Kristina Szabo
Martin Skalej
Siegfried Bien
Christoph Best
Hans-Ulrich Prokosch
Horst Urbach
Publication date
01-06-2018
Publisher
Springer Berlin Heidelberg
Published in
Clinical Neuroradiology / Issue 2/2018
Print ISSN: 1869-1439
Electronic ISSN: 1869-1447
DOI
https://doi.org/10.1007/s00062-017-0656-y

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