Hatcher Abigail Jeanne, West Anna Beth, Rajani Ravi R, Ramos Christopher R, Benarroch-Gampel Jaime
Emory University School of Medicine, Atlanta, GA.
Department of Surgery, Emory University School of Medicine, Atlanta, GA.
J Vasc Surg. 2023 Jan;77(1):63-68.e1. doi: 10.1016/j.jvs.2022.07.177. Epub 2022 Aug 6.
Despite an increasing rate of intraoperative consultation of vascular surgery (VS) for trauma patients, VS is not one of the subspecialties required for American College of Surgeons level I trauma center verification. We sought to assess the rates and patterns of emergent operative VS consultation compared with other surgical subspecialties in the trauma setting.
A retrospective analysis was performed on all patients who presented with traumatic injuries requiring emergent surgical operations (<3 hours after presentation) from 2015 to 2019 at a level I trauma center. Patient demographics, injury characteristics, and data on consulted surgical subspecialties were collected. The primary outcome measured was the rate of intraoperative consultation to VS and other subspecialties (OS).
A total of 2265 patients were identified, with 221 emergent intraoperative consults to VS and 507 consults to OS. After VS (9.8%), the most common subspecialties consulted were orthopedics (9.2%) and urology (5%). Overall, VS was more likely to be consulted in immediate trauma operations (<1 hour after presentation) (65.6% vs 38.1%, P < .0001), penetrating injuries (73.3% vs 47.9%, P < .0001), and at night (60.6% vs 51.9%, P = .02) compared with OS. Time from admission to operation was shorter for cases when VS was involved compared with OS (54.1 ± 40.4 vs 80.6 ± 47.9 minutes, P < .0001). In a multivariable logistic regression model, we found that requiring an immediate operation was associated with higher odds of requiring an intraoperative vascular consult (odds ratio = 1.49, 95% confidence interval = 1.12-2.0).
Vascular surgeons are consulted intraoperatively to assist with emergent trauma at a greater rate compared with specialties that are required for level I trauma center verification. Current American College of Surgeons verification processes and site-specific policies should be re-evaluated to consider VS coverage as a requirement for trauma center verification.
尽管创伤患者术中血管外科（VS）会诊率不断上升，但VS并非美国外科医师学会一级创伤中心认证所需的亚专业之一。我们试图评估在创伤环境中，与其他外科亚专业相比，急诊手术VS会诊的发生率和模式。
对2015年至2019年在一级创伤中心因创伤性损伤需要急诊手术（就诊后<3小时）的所有患者进行回顾性分析。收集患者人口统计学资料、损伤特征以及会诊外科亚专业的数据。测量的主要结局是术中VS会诊和其他亚专业（OS）会诊的发生率。
共识别出2265例患者，其中221例术中急诊会诊VS，507例会诊OS。仅次于VS（9.8%），最常会诊的亚专业是骨科（9.2%）和泌尿外科（5%）。总体而言，与OS相比，VS在即刻创伤手术（就诊后<1小时）（65.6%对38.1%，P<.0001）、穿透伤（73.3%对47.9%，P<.0001）以及夜间（60.6%对51.9%，P=.02）时更有可能被会诊。与OS相比，涉及VS的病例从入院到手术的时间更短（54.1±40.4对80.6±47.9分钟，P<.0001）。在多变量逻辑回归模型中，我们发现需要即刻手术与术中血管会诊的较高几率相关（比值比 = 1.49，95%置信区间 = 1.12 - 2.0）。
与一级创伤中心认证所需的专业相比，血管外科医生在术中被会诊以协助处理急诊创伤的比例更高。应重新评估当前美国外科医师学会的认证流程和特定地点政策，以考虑将VS覆盖作为创伤中心认证的一项要求。
