NESVS8. Emergency Intraoperative Vascular Surgery Consultations at a Tertiary Academic Center

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Vascular surgeons are frequently called on to provide emergency assistance to surgical colleagues. Whereas previous studies have included elective preoperative vascular consultations, we sought to characterize the breadth of assistance provided during urgent consultations at a single tertiary academic center. We queried our institutional billing department during a 15-year period (2000-2015) and identified unanticipated urgent vascular surgery intraoperative consultations from all surgical services. Patients’ demographics and comorbidities were recorded along with the consulting services, type of index operation, reasons for vascular consultation, anatomic regions intervened on, vascular interventions performed, and outcomes achieved. A total of 366 true emergency intraoperative consultations were identified. Patients were 51% male, with an average age of 57 years and body mass index of 28.4 kg/m2. Subspecialties assisted were most commonly surgical oncology (n = 114 [31%]), cardiac surgery (n = 76 [21%]), and orthopedics (n = 39 [11%]; Table). Index cases were elective/nonurgent (n = 280 [76.7%]), urgent (n = 24 [6.6%]), and emergent (n = 61 [16.7%]), with a majority involving tumor resection (n = 193 [53.2%]). The primary reason for vascular consultation was revascularization (n = 169 [47.4%]), control of bleeding (n = 120 [33.4%]), assistance with dissection/exposure (n = 40 [11.1%]), embolic protection (n = 25 [7.0%]), and other (n = 4 [1.1%]). The primary blood vessel and anatomic field of intervention were categorized (Fig). A majority of cases (n = 233 [61.3%]) involved preservation of blood flow, including primary arterial repair (n = 157 [43.1%]), patch angioplasty (n = 70 [19.2%]), bypass (n = 50 [13.7%]), and thrombectomy (n = 33 [9.1%]). Postoperative length of stay was 14 days, with 30-day and 1-year mortality of 7.7% and 27.0%. Vascular surgeons are called on to provide urgent open surgical consultations for a wide variety of specialties over wide-ranging anatomic regions employing a variety of skills and techniques. This study testifies to the essential services supplied to hospitals and our surgical colleagues as well as the broad skills and training necessary for modern vascular surgeons.TableRequesting service subspecialtyNo.%Surgical oncology11431.1Cardiac surgery7620.8Orthopedic surgery3910.7General and trauma surgery318.5Obstetrics-gynecology, gynecologic oncology308.2Urology256.8Thoracic surgery246.6Transplantation surgery143.8Other61.6Plastic surgery20.5Multiple teams51.4Total366100.0 Open table in a new tab