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Original Investigation
November 2016

Implications of Intraoperative Vascular Surgery Assistance for Hospitals and Vascular Surgery Trainees

Author Affiliations
  • 1Division of Vascular Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
JAMA Surg. 2016;151(11):1032-1038. doi:10.1001/jamasurg.2016.2247
Key Points

Question  What are the implications of intraoperative vascular surgery assistance for patients, hospitals, and trainees?

Findings  In this review of nonvascular surgeries requiring intraoperative vascular surgery assistance, vascular surgeons assisted a wide spectrum of surgical specialists. All operations required open surgical exposure by the vascular surgeon, and all vascular repairs were done using open technique, and the need for vascular repair was associated with higher incidence of death, myocardial infarction, or unplanned return to the operating room.

Meaning  Vascular surgeons frequently provide intraoperative assistance to other surgeons in procedures that require expertise in open anatomic exposure and vascular reconstruction.

Abstract

Importance  Vascular surgeons possess a skill set that allows them to assist nonvascular surgeons in the operating room. Existing studies on this topic are limited in their scope to specific procedures or clinical settings.

Objective  To describe the broad spectrum of cases that require intraoperative vascular surgery assistance.

Design, Setting, and Participants  A retrospective medical record review of patients undergoing nonvascular surgery procedures that required intraoperative vascular surgery assistance between January 2010 and June 2014 at a single urban academic medical center (Northwestern Memorial Hospital, Chicago, Illinois). Trauma patients and inferior vena cava filter placements were excluded.

Exposures  Intraoperative vascular surgery assistance stratified by need for vascular reconstruction, anatomic location, urgency of consultation, and timing of consultation.

Main Outcomes and Measures  A composite primary end point of death, myocardial infarction, or unplanned return to the operating room within 30 days of the index operation.

Results  We identified 299 patients involving 12 different surgical subspecialties that met the study criteria. The cohort included 148 men (49.5%) and had a mean (SD) age of 56.4 (15) years. Most consultations occurred preoperatively (n = 224; 74.9%; odds ratio, 0.04; 95% CI, 0.02-0.08; P < .001) and were elective (n = 212; 70.9%; odds ratio, 0.06; 95% CI, 0.03-0.12; P < .001 ). The indications for vascular surgery assistance were 156 spine exposure (52%), 43 vascular control without hemorrhage (14.4%), 43 control of hemorrhage (14.4%), and 57 vascular reconstruction (19%). Vascular repairs consisted of 13 bypasses (4.3%), 18 patch angioplasties (6.0%), and 79 primary repairs (26.4%). All procedures required open surgical exposure by the vascular surgeon. The incidence of death, myocardial infarction, or unplanned return to the operating room was 11.4% for the cohort with a mortality rate of 1.7%. Patients who required vascular repair had a higher incidence of death, myocardial infarction, or unplanned return to the operating room (17.4% vs 7.9%; P = .01). These cases resulted in an additional 1371.46 work relative value units per year.

Conclusions and Relevance  Vascular surgeons provide crucial operative support across multiple specialties. Although vascular reconstruction is not needed in most patients, it may be associated with increased risk of death, myocardial infarction, or unplanned return to the operating room. The high proportion of emergent cases that require vascular repair demonstrates the importance of having vascular surgeons immediately available at the hospital. To continue providing this valuable service, vascular surgery trainees need to continue to learn the full breadth of open anatomic exposures and vascular reconstruction.

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