Another study has emerged showing vascular surgery’s heavy intraoperative consult activity in a level 1 trauma center setting, lending further fuel to the “vascular firefighter” analogy.
A research team that included fourth-year medical student Abigail Hatcher, MS, of Emory University School of Medicine, Atlanta, and study lead Jaime Benarroch-Gampel, MD, assistant professor of vascular surgery, found that vascular surgery was consulted at a higher rate in both emergent and immediate operative trauma cases than any other surgical subspecialty at Atlanta’s Grady Hospital over a five-year period from 2015–2019.
Hatcher and colleagues noted that the retrospective analysis showed vascular consults ahead of orthopedic surgery and neurosurgery, both of which—unlike vascular surgery—are required in order for an institution to attain American College of Surgeons (ACS) level 1 trauma center certification.
Overall, vascular surgery was the only surgical group to see a statistically significant upward trend in intraoperative consultation over the period, whereas the other top surgical subspecialties did not experience any statistically significant change, Hatcher revealed. On multivariate analysis, she continued, “immediate trauma operations, younger patients, and those who presented with a severe injury severity score were independently associated with intraoperative vascular surgery consultation.”
The results were presented at the 2022 Southern Association for Vascular Surgery (SAVS) annual meeting in Manalapan, Florida (Jan. 19–22) by Hatcher, who told delegates the team hopes to expand the study by recruiting other level 1 trauma centers regionally and nationally in order to more broadly analyze consultation rates of surgical subspecialties. “We propose an assessment of the financial impact of vascular surgery’s contribution in trauma centers, and the adequacy of on-call coverage by vascular surgeons,” said Hatcher, who plans to enter general surgery residency on completion of her medical degree. “We recommend a re-evaluation of not only ACS but regional and local guidelines and polices to reflect our findings and the importance of vascular surgery in the trauma setting.”
Study development
Speaking to Vascular Specialist after presenting the data, Hatcher and Benarroch-Gampel described how their coming together, mentee with mentor, got the research project rolling.
Hatcher’s background interest in healthcare policy and Benarroch-Gampel’s robust experience of vascular surgery’s need at the coalface of a level 1 trauma center seeded the endeavor.
“We work incredibly well with our trauma peers here, and we get along incredibly well, and I have seen how much we assist them when they need us,” explained Benarroch-Gampel. “That brought us to the question: vascular surgeons in one of the busiest trauma hospitals in the nation, though we are pretty involved with them, how come we’re not what we call part of the table? The ACS guidelines for level 1 trauma certification does not require vascular surgery—why not?”
That’s when the team decided they needed to compare vascular surgery’s trauma consult rate with the other surgical subspecialties. As they sifted through the data, they discovered that of 2,265 patients identified, 221 required vascular consultation, which compared with 507 across the other surgical subspecialties combined. Hatcher, Benarroch-Gampel and colleagues further found that in addition to vascular surgery recording the highest rate of intraoperative consultation overall, it also saw the highest rate among consultations on cases classed as “immediate,” or patients taken to the operating room in under 60 mins.
“Abigail did a really good job finding the data because after I saw what it told us, I said, ‘Wow, we actually come out with more than the required subspecialties in emergent cases,’” said Benarroch-Gampel. “And I call them emergent because if you have six hours to fix a problem, you can just send the patient somewhere. But if you have to fix the problem in hours, you better have the way to fix the problem in hours.”
Armed with such evidence of vascular surgery’s import in the level 1 trauma setting, the researchers continue to mull over how best the certification anomaly might be rectified. “It takes buy-in from not only other vascular surgeons and programs across the country—because this is a nationwide guideline that we’re addressing—but also the individual hospitals and the trauma teams that you’re assisting,” said Hatcher. “It’s not something that is going to happen overnight, but it is an appropriate change to start talking about and working towards.”
In the meantime, it is imperative that vascular surgery continue to provide a high level of assistance in trauma cases when called upon, Benarroch-Gampel said. There are signs of promise, added Hatcher, who noted major changes to the ACS guidelines in the past, suggesting further updates of this nature “are not out of the realm of possibilities.”
Important cog in healthcare wheel
The Society for Vascular Surgery (SVS) last year published a document chronicling the value of the modern vascular surgeon to the healthcare system. The report from the SVS Valuation Work Group highlighted the unique mix of medical, open surgical and endovascular skills vascular surgeons provide, along with the critical role they play in a safe operating room environment. Benarroch-Gampel said the Atlanta studies represents yet another example that can be used to show how important vascular surgeons are to healthcare systems. “In many cases, we are called the firefighters,” he elaborated. “The value we provide should be highlighted. And the value we provide should be appreciated. Here, it is. We just need to be sure that nationwide this is something where people understand what vascular surgeons provide.”
Benarroch-Gampel said his group previously published data showing that they had seen a rise in their vascular trauma workload—from about 12% to nearly 80%—with good results. “As a society, we need to support that; we need to show that in the vascular trauma field, we are providing a good job compared to other specialties.”
The research team’s attention now turns to getting their latest data published, but Hatcher disclosed that the SAVS meeting room has already yielded interest from senior vascular surgeons about chipping in with data from their own institutions. “They said, ‘We would love to offer our data over the same time period, or a similar time period,’ to see if this is something that they think they’re already experiencing, but they also want to prove, and contribute to a wider dataset.” For Benarroch-Gampel, the question beckons: Are these results isolated to the Atlanta data, or are they occurring across the country? “I personally believe this is nationwide, and not just in one place,” he said. “This is one of the busiest places, with one of the most well-trained trauma surgeon teams, and we still come in and assist when needed.”
