Transcatheter arterial embolization of acute bleeding as 24/7 service: predictors of outcome and mortality

Abstract

Objective: To analyze times of occurrence and identify risk factors (RFs) for technical and clinical failure and mortality of transcatheter arterial embolization (TAE) of acute bleeding in a major hospital.

Methods: All TAEs performed at our hospital from 2006 to 2013 (n = 327) were retrospectively analyzed.

Results: TAEs were performed during regular weekday hours in 165 (50%) and during off-hours in 162 (50%) cases. With 40 regular and 128 off-hours/week, 3.25 times more TAEs were performed during regular hours. There was an even distribution across weekdays (Mon-Fri:16.9 ± 1.5%), while fewer TAEs were performed on weekends (Sat: 8.3%, Sun: 7.3%). Technical success of TAEs was 93.9% with a clinical success of 79.2% and a 30-day mortality of 18.4%. Shock was an RF for technical failure (p = 0.022). RFs for clinical failure were low hemoglobin (Hb) (p = 0.021) and transfusion of ≥6 units packed cells (p = 0.009). Independent RFs for mortality were clinical failure (p < 0.001), coagulopathy (p = 0.005), and shock (p < 0.001).

Conclusion: Our results provide no evidence for a subjectively perceived increase in TAEs during off-hours but rather appear to show that most TAEs are performed during regular hours. Prompt TAE to control acute bleeding is crucial to prevent a drop in Hb with shock and the need for transfusion, which may promote coagulopathy and rebleeding, all of which are risk factors for a negative outcome.

Advances in knowledge: The presented analysis provides insights of occurrences and risk factors for success of transcatheter arterial embolization in acute bleeding in a large study population.

Figure 1.

(A) Percentage of TAEs performed during regular hours and off-hours. (B) From Mondays through Fridays, there is a peak in the number of TAEs during regular hours with a drop beginning at the end of regular hours and continuing through the night to the morning of the next day (beginning of regular hours). (C) TAEs are evenly distributed across weekdays (Mondays through Fridays) with a smaller number during weekends. (D) shows the fairly even distribution of TAEs through the year. TAEs, transcatheter arterial embolizations.