Vascular firefighters: New data highlight ‘essential hospital resource’

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Cassandra Soto

New data that analyze the preoperative and intraoperative assistance vascular surgeons provide to other surgical subspecialties underscores “the essential hospital resource” that vascular surgery represents.

These findings by a team of researchers from Robert Wood Johnson Medical School at Rutgers University and Robert Wood Johnson University Hospital in New Brunswick, New Jersey, were reported at the Vascular & Endovascular Surgery Society (VESS) winter annual meeting (Jan. 21–24). Furthermore, the data uncovered demonstrates the importance of ensuring that “trainees are comfortable with both open and endovascular techniques because when they’re called to assist for their colleagues they’re using both to assist,” first-named author, Cassandra Soto, a fourth-year medical student at Rutgers, told the VESS gathering.

Soto et al set out to build upon previous research showing vascular surgeons—often referred to as the firefighters of the operating room (OR) owing to their breath of training across open, endovascular and hybrid techniques—were most commonly called in to assist surgical oncology and cardiothoracic surgery for intraoperative complications across elective, urgent and emergent cases.

“We wanted to evaluate not only the intraoperative consultations but also those where surgeons were being called preoperatively and informed that they would be needed for vascular assist in the case—we wanted to focus on the more urgent setting,” explained Soto.

The research team evaluated 484 cases retrospectively at a single institution between 2011 and 2020, with 100 vascular specialists listed as a secondary surgeon and a non-vascular physician as primary. The investigators excluded 350 elective cases. A total of 49 classified as urgent (with the patient heading to the OR within six hours) and 85 as emergent (with patients taken to the OR within one hour) were included.

Soto and colleagues found that those who primarily called for vascular help were orthopedic surgeons, acute care surgery and cardiothoracic surgery, followed by the likes of general surgery, surgical oncology and plastic surgery.

About 44.8% of the cases where vascular surgery was called in to assist involved the relevant surgeons being informed preoperatively they would be needed, while the remaining 55.2% were intraoperative consultations.

Acute care and cardiothoracic surgery were shown to be the subspecialties mostly calling for intraoperative consultations, while orthopedic surgery more often called preoperatively in need of assistance, Soto said.

She further explained that about 28.4% of the cases occurred after hours, while, in terms of type of assistance required, some 35% were for revascularization followed by 33% for bleeding. Interestingly, added Soto, about 13.4% of the overall cases were for inferior vena cava (IVC) filter placements.

Drilling down further, the researchers discovered that 71.6% of the calls involved assisting in the open surgical setting, with only about 26.1% involving an endovascular intervention. “Very few required a hybrid approach,” Soto said.

The reasons that drive other subspecialties to call on vascular assistance will vary by institution, Soto concluded, but the ability of vascular surgeons to use open, endovascular and hybrid techniques means they are prepared to respond and intervene in non-vascular cases when unexpected vascular compromise, iatrogenic injury or challenging exposures are encountered.

“What this does is emphasize that vascular surgery is an essential hospital resource, especially for institutions that provide urgent-emergent care,” she said, “and that it’s important to ensure that trainees are comfortable with both open and endovascular techniques, because when they’re called to assist for their colleagues, they’re using both to assist.”

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