Intraoperative consultation of vascular surgeons is increasing at a major American trauma center

• Published in: Journal of vascular surgery Vol. 74; no. 5; pp. 1581 - 1587
• Main Authors: Hemingway, Jake F., Desikan, Sarasijhaa, Dasari, Mohini, Tran, Cuong, Hoffman, Rachel, Gobble, Alexandra, Spurlock, Aaron, Singh, Niten, Quiroga, Elina, Tran, Nam, Starnes, Benjamin W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021
• Subjects: Adult; Consultation; Female; Hemorrhage - surgery; Hemostatic Techniques - trends; Humans; Intraoperative; Intraoperative Care - trends; Male; Orthopedic Procedures - trends; Patient Care Team - trends; Physician's Role; Referral and Consultation - trends; Retrospective Studies; Surgeons - trends; Time Factors; Trauma; Trauma Centers - trends; United States; Vascular Surgical Procedures - trends; Vascular System Injuries - surgery; United States; Intraoperative; Trauma; Consultation
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2021.04.065

Vascular surgeons are often called to aid other surgical specialties for complex exposure, hemorrhage control, or revascularization. The evolving role of the vascular surgeon in the management of intraoperative emergencies involving trauma patients remains undefined. The primary aims of this study included determining the prevalence of intraoperative vascular consultation in trauma, describing how these interactions have changed over time, and characterizing the outcomes achieved by vascular surgeons in these settings. We hypothesized that growing endovascular capabilities of vascular surgeons have resulted in an increased involvement of vascular surgery faculty in the management of the trauma patient over time. A retrospective review of all operative cases at a single level I trauma center where a vascular surgeon was involved, but not listed as the primary surgeon, between 2002 and 2017 was performed. Cases were abstracted using Horizon Surgical Manager, a documentation system used in our operating room to track staff present, the type of case, and use. All elective cases were excluded. Of the 256 patients initially identified, 22 were excluded owing to the elective or joint nature of the procedure, leaving 234 emergent operative vascular consultations. Over the 15-year study period, a 529% increase in the number of vascular surgery consultations was seen, with 65% (n = 152) being intraoperative consultations requiring an immediate response. Trauma surgery (n = 103 [44%]) and orthopedic surgery (n = 94 [40%]) were the most common consulting specialties, with both demonstrating a trend of increasing consultations over time (general surgery, 1400%; orthopedic surgery, 220%). Indications for consultation were extremity malperfusion, hemorrhage, and concern for arterial injury. The average operative time for the vascular component of the procedures was 2.4 hours. Of patients presenting with ischemia, revascularization was successful in 94% (n = 116). Hemorrhage was controlled in 99% (n = 122). In-hospital mortality was relatively low at 7% (n = 17). Overall, despite the increase in intraoperative vascular consultations over time, a concomitant increase in the proportion of procedures done using endovascular techniques was not seen. Vascular surgeons are essential team members at a level I trauma center. Vascular consultation in this setting is often unplanned and often requires immediate intervention. The number of intraoperative vascular consultations is increasing and cannot be attributed solely to an increase in endovascular hemorrhage control, and instead may reflect the declining experience of trauma surgeons with vascular trauma. When consulted, vascular surgeons are effective in quickly gaining control of the situation to provide exposure, hemorrhage control, or revascularization. [Display omitted]