N. A. Ludwig1, N. Bhutiani1, B. G. Harbrecht1, A. J. Dwivedi1, M. C. Bozeman1 1University of Louisville,Surgery,Louisville, KY, USA
Introduction: Despite several studies across a variety of procedures demonstrating no significant improvement in outcomes associated with high-volume surgeon specialty, some groups in the United States have increasingly advocated for specialty-specific surgical intervention. This study sought to evaluate the impact of operative surgeon specialty on perioperative outcomes following repair of traumatic vascular injuries.
Methods: A level 1 trauma center registry was queried for patients with extremity vascular injuries between January 2010 and March 2018. Patients were classified with respect to the specialty of the service (trauma surgery, vascular surgery) that performed operative repair of their vascular injury. Demographic, injury, and perioperative outcome variables were compared.
Results: Of 217 patients undergoing surgical repair of an extremity vascular injury, 142 had repairs performed by trauma surgery and 75 had repairs performed by vascular surgery. Patient cohorts did not differ with respect to age, gender, abbreviated injury severity, or injury severity score (Table). Regarding location of vascular injury, patients undergoing repair by trauma surgery were more likely to have injuries to the axillary/subclavian artery, iliac artery, and femoral artery and less likely to have injuries to the brachial or popliteal artery than patients undergoing repair by vascular surgery. Patients undergoing repair by vascular surgery were more likely to be admitted to the intensive care unit (ICU) postoperatively (96.0% vascular surgery vs. 83.1% trauma surgery, p=0.005). ICU length of stay, mechanical ventilation requirement, and duration of mechanical ventilation did not differ between groups, nor did requirement for amputation during index hospitalization. Regarding mortality and discharge destination, groups did not differ with respect to mortality during index hospitalization, though patient undergoing repair by trauma surgery were more likely to be discharged home with or without home health (76.1% trauma surgery vs. 57.3% vascular surgery, p=0.005).
Conclusion: Among patients with traumatic extremity vascular injuries, operative surgeon specialty does not significantly impact perioperative outcomes. As evidenced by a greater likelihood of vascular surgery involvement in brachial and popliteal artery injuries, surgeon comfort and experience with vascular exposures do and should factor into the decision to involve a vascular surgeon in patient care. Still, the data suggest that the training and exposure received by trauma surgery is sufficient to provide high quality care for patients with traumatic extremity vascular injuries.
