IP245. The Role of Vascular Surgeons Is Increasing in the Management of Trauma

Vascular surgeons are called to aid other surgical specialties for complex exposure, hemorrhage control, and revascularization. The changes in training paradigms have led to an increase in vascular surgery participation with trauma patients. This study reviews the incidence, indications, and outcomes of emergent operative vascular consultations at a level I trauma center during a 15-year period. All operative cases in which a vascular surgeon was involved but not listed as the primary surgeon were abstracted during the study period (2002-2017) through Horizon Surgical Manager, a documentation system used in our operating room to track staff present, type of case, and utilization. Initially, 256 patients were identified; 22 patients were excluded because the case was a joint or elective procedure. This left 234 emergent operative vascular consultations; 65% (n = 152) were intraoperative consultations requiring an immediate response. The mean age of the patients was 38 years, with a 73% male predominance. The majority of consultations were for trauma (n = 189 [81%]), followed by iatrogenic injury (n = 32 [14%]). The most common consulting services were trauma surgery (n = 103 [44%]) and orthopedic surgery (n = 94 [40%]). Frequent indications for consultation were extremity malperfusion, hemorrhage, and concern for arterial injury (Table). 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, there has been a significant trend toward increased vascular operative consultations during the study period (Fig). Vascular surgeons are essential team members at a level I trauma center. Vascular consultation in this setting is often unplanned and requires immediate intervention. When consulted, the vascular surgery service is effective in quickly gaining control of the situation to provide exposure, hemorrhage control, and revascularization if warranted. The frequency of vascular consultation is increasing, and it is paramount that hospitals provide adequate staffing to meet rising demand. Declining experience of trauma surgeons with vascular trauma may have an influence on this increase in demand.TableCharacteristics of emergent vascular operative consultationNo. (%)Consulting service General surgery103 (44) Orthopedic surgery94 (40) Other37 (16)Reason for consultation Extremity malperfusion86 (37) Hemorrhage62 (26) Arterial injury46 (20) Assistance with exposure14 (6) Other26 (11)Operationa Primary repair85 (33) Bypass42 (17) Intraoperative assessment35 (14) Ligation21 (8) Assistance with exposure14 (6) Endovascular12 (5) Other43 (17)Location of vascular concerna Lower extremity108 (45) Upper extremity40 (17) Head and neck36 (15) IVC/iliac veins33 (14) Aorta21 (9)IVC, Inferior vena cava.aTotal may not always equal 234 as patients may have had multiple procedures or vascular injuries. Open table in a new tab