Trends in Open Vascular Surgery For Trauma: Implications for the Future of Acute Care Surgery

• Published in: The Journal of surgical research Vol. 205; no. 1; pp. 208 - 212
• Main Authors: Forrester, Joseph D., MD, MSc, Weiser, Thomas G., MD, MPH, Maggio, Paul, MD, MBA, Browder, Timothy, MD, Tennakoon, Lakshika, MSc, Spain, David, MD, Staudenmayer, Kristan, MD, MS
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2016
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Emergency Medical Services - statistics & numerical data; Emergency Medical Services - trends; Female; General Surgery - statistics & numerical data; General Surgery - trends; Humans; Male; Middle Aged; Open vascular repair; Resident training; Retrospective Studies; Surgery; Trauma; Trauma Centers - statistics & numerical data; Trauma Centers - trends; Vascular surgery; Vascular Surgical Procedures - trends; Vascular trauma; Young Adult; trauma; resident training; vascular surgery; vascular trauma; open vascular repair; Vascular surgery; Vascular trauma; Open vascular repair; Trauma; Resident training
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2016.06.032

Background Trauma patients with vascular injuries have historically been within a general surgeon’s operative ability. Changes in training and decline in operative trauma have decreased trainees’ exposure to these injuries. We sought to determine how frequently vascular procedures are performed at U.S. trauma centers to quantify the need for general surgeons trained to manage vascular injuries. Methods We conducted a retrospective analysis of the National Trauma Data Base® (NTDB) from 2012 compared to 2002. Patients with general surgical and vascular procedures were identified using International Classification of Diseases, 9th Revision, procedure codes 38.0-39.99, excluding 38.9-38.99. Results General surgery or vascular operations were performed on 12,099 (24%) of 50,248 severely-injured adult patients in 2002, and 21,854 (16%) of 138,009 injured patients in 2012. Nineteen to 26% of all patients underwent vascular procedures. Patients with combined general surgery and vascular procedures were less likely to be discharged home and more likely to die. In 2002, 6% of severely-injured adult trauma patients underwent open vascular procedures at Level III/IV trauma centers; by 2012 only 1% of vascular surgery procedures were performed at Level III/IV centers (p<0.001). Conclusions Need for emergent vascular surgery remains common for severely-injured patients. Future trauma systems and surgical training programs will need to account for the need for open vascular skills. The findings suggest there is already a trend away from open vascular procedures at Level III/IV trauma centers, which may be a sign of system compensation for changes in the workforce.