Vascular Surgery is the Most Commonly Consulted Specialty for Emergent Operative Trauma.

Abstract

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 (ACS) Level I trauma center verification. We sought to assess rates and patterns of emergent operative VS consultation compared to other surgical subspecialties in the trauma setting. A retrospective analysis was performed on all patients who presented with traumatic injuries requiring emergent surgical operations (<3hrs 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). 2,265 patients were identified, with a total of 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 (<1hr 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 to OS. Time from admission to operation was shorter for cases when VS was involved compared to OS (54.1±40.4 vs 80.6±47.9 min, 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 (OR=1.49, 95% CI=1.12-2.0.) CONCLUSIONS: Vascular surgeons are consulted intraoperatively to assist with emergent trauma at a greater rate compared to specialties that are required for Level I trauma center verification. Current ACS verification processes and site-specific policies should be re-evaluated to consider vascular surgery coverage as a requirement for trauma center verification.