Intraoperative vascular consults have risen 529% in last 15 years, single-center analysis finds

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Jake Hemingway

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.

The group conducted a study reported in the November 2021 issue of the Journal of Vascular Surgery.

“The evolving role of the vascular surgeon in the management of intraoperative emergencies involving trauma patients remains undefined,” said first author Jake Hemingway, MD. “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 chief of vascular surgery 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%) and unusual pathology (5%), with indications for consultation recorded as extremity ischemia (37%), hemorrhage (26%), arterial injury (20%) and need for exposure (6%).

“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 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.

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