Study Shows Intraoperative Vascular Surgeon Consultations are Increasing at a Major American Trauma Center
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Findings Reinforce Vascular Surgeons’ Value for Trauma Centers
Rosemont, Ill., Nov. 19, 2021 – According to researchers from the University of Washington Level 1 Trauma Center, the number of intraoperative vascular surgeon consultations has increased enormously over the past decade. Their study was reported in the November 2021 issue of the Journal of Vascular Surgery. Vascular surgeons, researchers said, provide a unique mix of medical, open surgical and endovascular skills, and fulfill a vital role in the continuum of care of patients with vascular disease. Because vascular surgeons are effective in quickly gaining control of trauma situations, they often are called on to assist other surgical specialties for complex exposure, hemorrhage control or revascularization.
According to first author Jake Hemingway, MD, “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 this setting.”
Researchers from the University of Washington in Seattle, led by Benjamin Starnes, MD, performed a single-center retrospective evaluation of 234 intraoperative consultations by vascular surgeons at their hospital from 2002 to 2017.
The team found that over the course of 15 years, the number of consultations increased by 529%. Sixty-five percent of these consultations required an immediate intraoperative response. Further, there was a 1,400% increase in general/trauma surgery consultations per year throughout this period.
Consultations were for:• Trauma 81%• Latrogenic injury 14%• Unusual pathology 5%
The indications for consultation included:• Extremity ischemia 37%• Hemorrhage 26%• Arterial injury 20%• Need for exposure 6%
The outcomes achieved by the vascular surgeons included:• Successful revascularization 94%• Control of hemorrhage 99%• In-hospital mortality 7.3%• Mean operative time 2.4 hours
“The most common reason for the increase in vascular involvement in the management of a trauma patient is likely multifactorial, but may be influenced by a declining trauma surgeon familiarity with vascular repair. Multiple studies have demonstrated the decreasing vascular experience of general surgery residents over time,” said Dr. Hemingway.
This changing role has significant financial implications, he said. “As vascular surgeons become increasingly essential team members at a level I trauma center, one may argue that the 24-hour in-house availability of vascular surgeons might be mandated,” Hemingway continued. “Looking forward, it will be important to quantify the financial and safety implications of these changing trends in order to demonstrate the value that vascular surgeons bring to a level I trauma center outside of standard clinical practice.”
This study reinforces the increasing value that vascular surgeons bring to hospital systems and patient care, and highlights vascular surgeons are critical to a safe operating room environment, said JVS editors.
About the Society for Vascular SurgeryThe Society for Vascular Surgery is the leading not-for-profit, professional medical society on establishing causes and treatments for vascular disease. SVS seeks to advance excellence and innovation in vascular health through education, advocacy, research and public awareness and is composed of specialty-trained vascular surgeons who are dedicated to providing comprehensive care for vascular disease. For more information visit www.vascular.org. Follow the SVS on Facebook @VascularHealth, Twitter @VascularSVS and Instagram @societyforvascularsurgery.