Fifteen years’ worth of data from a major US trauma centre suggest that the involvement of vascular surgeons in trauma management has increased over time. Based on this finding, authors Jake F Hemingway (University of Washington, Seattle, USA) and colleagues argue in the Journal of Vascular Surgery (JVS) that it may be time to mandate the ready availability of vascular surgeons in major trauma centres.
The investigators state that, before conducting their analysis, the evolving role of the vascular surgeon in the management of intraoperative emergencies involving trauma patients was undefined. The team therefore set out to determine the prevalence of intraoperative vascular consultation in trauma, describe how these have changed over time, and also to characterise the outcomes achieved by vascular surgeons in these settings.
Hemingway and colleagues performed a retrospective review of all operative cases at a single level I trauma centre where a vascular surgeon was involved, but was not listed as the primary surgeon, over a 15-year period (2002–2017).
Writing in JVS, the authors report seeing a 529% increase in the number of vascular surgery consultations, with 65% (n=152) being intraoperative and therefore requiring an immediate response. Indications for consultation were extremity malperfusion, haemorrhage, and concern for arterial injury, the authors relay.
Regarding the outcomes achieved by vascular surgeons in trauma settings, Hemingway et al note that, when consulted, they are “effective in quickly gaining control of the situation to provide exposure, haemorrhage control, or revascularisation”.
While the research team had theorised that an increased involvement of vascular surgery faculty in trauma patient management would be the result of growing endovascular capabilities, this was not the case. Instead, the authors suggest that the reasons underlying this shift towards increased vascular involvement in the management of a trauma patient “are likely multifactorial, and may be influenced by a decreased trauma surgeon familiarity with vascular repair,” based on the changes in the experience provided by general surgeons over time.
“Regardless of the reason for increasing consultation,” the authors write in their conclusion, the changing role of a vascular surgeon is significant. As they become “increasingly essential team members at a level I trauma centre,” they elaborate, “one may argue that the 24-hour in-house availability of vascular surgeons at a level I trauma centre should be mandated”.