Vascular Surgery is the Most Commonly Consulted Specialty for Emergent Operative Trauma
Abigail Hatcher, Anna West, Ravi Rajani, Christopher Ramos, Jaime Benarroch-Gampel
Emory University, Atlanta, GA
BACKGROUND: Despite an increasing rate of intraoperative consultation of vascular surgery for trauma patients, vascular surgery is not one of the subspecialties required for American College of Surgeons (ACS) Level I trauma center verification. We sought to assess rates and patterns of emergent operative vascular surgery consultation compared to other surgical subspecialties in the trauma setting. METHODS: A retrospective analysis was performed on all patients who presented with traumatic injuries requiring emergent surgical operations (<3 hrs) from January 1, 2015 to December 31, 2019 at a level 1 trauma center. Patient demographics, injury characteristics, and data on consulted surgical specialties were collected. The primary outcome measured was the rate of intraoperative consultation to vascular surgery (VS) and other subspecialties (OS). RESULTS: 2,265 patients were identified, with a total of 221 emergent operative consults to VS and 507 consults to OS. After VS (9.8%), the most common subspecialties consulted were orthopedics (9.2%) and urology (5%) (Figure 1). Overall, VS was more likely to be consulted in immediate trauma operations (<1 hr) (65.6% vs. 38.1, P<.0001), penetrating injuries (73.3% vs. 47.9%, P<.0001), blunt injuries (19.15% vs. 5.26%, P<.0001) and at night (60.6% vs 51.9%, P=.02) when compared to OS. Time from admission to operation was shorter for cases when VS was involved compared to OS (54.1±40.4 min vs 80.6±47.9 min, P<.0001). In a multivariable logistic regression model predicting immediate trauma operations (<1hr), VS was 43% more likely to be involved compared to OS (OR=1.43; 95% CI=1.05–1.95). CONCLUSIONS: Vascular surgeons are consulted intraoperatively to assist with emergent trauma at a greater rate compared to specialties that are required for Level I trauma center verification. Current ACS verification processes and site-specific policies should be re-evaluated to consider vascular surgery coverage as a requirement for trauma center verification.
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