“Call Vascular”: Vascular Surgery an Indispensable Service in a Highly Functional Complex Hospital System

Abstract

With the maturation of vascular surgery as an independent specialty, vascular surgeons have become an essential resource in any hospital system. Not only do vascular surgeons provide the breadth of open and endovascular treatment to patients with vascular disease, but they are also an important resource for other surgical subspecialties, providing open exposure, control of life-threatening hemorrhage, repair and reconstruction of blood vessels, using both open and endovascular techniques. We conducted a retrospective review of the concurrent intraoperative involvement of vascular surgery with another surgical service at tertiary care, level 1 trauma designated academic medical center over a ten-year period in which vascular surgery was consulted to assist another surgical service. The consults were classified as intraoperative, emergent in which vascular surgery was consulted prior to surgery either in the emergency department or in the hospital and electively scheduled procedures. We identified 362 cases in which vascular surgery was consulted for operative assistance by another surgical service from August 2012 to May 2022. This equates to approximately three consults per month. The majority (57%) were trauma cases. Of the nontrauma-related cases, 33% were intraoperative consults, 35% emergent, and 32% were electively scheduled procedures. Of the trauma cases, 50% were intraoperative consults and 50% emergent consults (Table I). The most common reason for a vascular surgery consult on a trauma patient was limb ischemia (65%), followed by assistance with uncontrolled hemorrhage (25%). The most common reason for a vascular surgery consult on a nontrauma patient was for assistance with exposure (52%) followed by uncontrolled hemorrhage (21%) (Table II). The specialties requiring vascular assistance included trauma surgery, general surgery, urology, orthopedic surgery, plastic surgery, obstetrics/gynecology, neurosurgery, cardiothoracic surgery, transplant surgery, surgical oncology, orthopedic oncology, pediatric surgery, ENT, and cardiology. Vascular surgery provides operative support to and collaboration with every other surgical specialty. In the majority of cases, vascular surgery is consulted either intraoperatively or emergently. In addition to providing care to patients with vascular disease, vascular surgeons assist other specialists in providing care to their patients. Vascular surgeons are a crucial resource for a hospital, and it is essential for hospitals to have full-time vascular surgery availability.Table IType of consultNontraumaTraumaAll cases regardless of trauma statusIntraoperative consults51103154 (43%)Emergent consults54105159 (44%)Elective consults49049 (13%)Total154 (43%)208 (57%)362 (100%) Open table in a new tab Table IIReason for vascular consultNon-traumaTraumaAll cases regardless of trauma statusUncontrolled hemorrhage335184 (23%)Limb ischemia31135166 (46%)Organ ischemia10212 (3%)Exposure8020100 (28%)Total154 (43%)208 (57%)362 (100%) Open table in a new tab