Implications of intraoperative vascular surgery assistance for hospitals and vascular surgery trainees

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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.

Original languageEnglish (US)
Pages (from-to)1032-1038
Number of pages7
JournalJAMA surgery
Volume151
Issue number11
DOIs
StatePublished - Nov 1 2016

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Blood Vessels
Operating Rooms
Myocardial Infarction
Referral and Consultation
Odds Ratio
Hemorrhage
Vena Cava Filters
Incidence
Angioplasty
Medical Records
Spine

ASJC Scopus subject areas

  • Surgery

Cite this

@article{a14f9d5e2cca4887afed97c2fbc6989c,
title = "Implications of intraoperative vascular surgery assistance for hospitals and vascular surgery trainees",
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.",
author = "Tomita, {Tadaki M.} and Rodriguez, {Heron E.} and Hoel, {Andrew W.} and Ho, {Karen J.} and Pearce, {William H.} and Eskandari, {Mark K.}",
year = "2016",
month = "11",
day = "1",
doi = "10.1001/jamasurg.2016.2247",
language = "English (US)",
volume = "151",
pages = "1032--1038",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "11",

}

TY - JOUR

T1 - Implications of intraoperative vascular surgery assistance for hospitals and vascular surgery trainees

AU - Tomita, Tadaki M.

AU - Rodriguez, Heron E.

AU - Hoel, Andrew W.

AU - Ho, Karen J.

AU - Pearce, William H.

AU - Eskandari, Mark K.

PY - 2016/11/1

Y1 - 2016/11/1

N2 - 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.

AB - 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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