Vascular surgeons typically assist in nonvascular operations

A retrospective review found that vascular surgeons often provided assistance to other surgeons when they perform nonvascular operations.

Lead researcher Tadaki M. Tomita, MD, of Northwestern University, and colleagues published their findings online in JAMA Surgery on Aug. 3.

The researchers analyzed 299 patients who underwent nonvascular surgery procedures and required intraoperative vascular surgery assistance between January 2010 and June 2014 at Northwestern Memorial Hospital in Chicago. They excluded trauma patients and patients who had an inferior vena cava filter placement.

Of the patients, 49.5 percent were men, and the mean age was 56.4 years old. In addition, 70.9 percent of the surgeries were elective, while 74.9 percent occurred preoperatively.

The most common indications for vascular surgery assistance were spine exposure (52 percent), vascular reconstruction (19 percent), vascular control without hemorrhage (14.4 percent) and hemorrhage (14.4 percent). Of the vascular repairs, 4.3 percent were bypasses, 6.0 percent were patch angioplasties and 26.4 percent were primary repairs.

Twelve subspecialties requested intraoperative assistance, including 33.8 percent from neurosurgery, 26.4 percent from orthopedic surgery, 15.7 percent from urology and 6.7 percent from surgical oncology.

The 30-day mortality rate was 1.7 percent, while the incidence of death, MI or unplanned return to the operating room was 11.4 percent. The incidence of death, MI or unplanned return to the operation room was 17.4 percent in patients who required vascular repair and 7.9 percent in patients who did not have vascular repair.

There was no difference in the incidence of death, MI or unplanned return to the operation room for venous vs. arterial involvement, anatomic location, timing of consultation or urgency of consultation.

The researchers cited a few limitations of the study, including that it did not have a control group of patients that did not receive assistance from a vascular surgeon. The patients in the trial were heterogeneous in terms of baseline comorbidities and index operation, as well. In addition, patients underwent a variety of operations. Further, the results may not be generalizable to other hospitals or institutions.

“Although unplanned vascular reconstruction is not needed in most patients, it may be associated with increased risk of [death, MI or unplanned return to the operation room] when performed,” the researchers wrote. “While most consultations occurred preoperatively, a high proportion of emergent cases that are more likely to require vascular repair demonstrates the importance of having vascular surgeons immediately available at the hospital. To continue providing this valuable service, vascular surgery trainees will need to continue to learn the full breadth of anatomic exposures and open vascular reconstruction.”