Faculty Collaboration Database

Trauma surgeon-performed peripheral arterial repairs are associated with equivalent outcomes when compared with vascular surgeons. J Trauma Acute Care Surg 2022 Apr 01;92(4):754-759

Date

01/11/2022

Pubmed ID

35001022

DOI

10.1097/TA.0000000000003531

Scopus ID

2-s2.0-85125891961 (requires institutional sign-in at Scopus site)   8 Citations

Abstract

BACKGROUND: Civilian extremity trauma with vascular injury carries a significant risk of morbidity, limb loss, and mortality. We aim to describe the trends in extremity vascular injury repair and compare outcomes between trauma and vascular surgeons.

METHODS: We performed a single-center retrospective review of patients 18 years or older with extremity vascular injury requiring surgical intervention between January 2009 and December 2019. Demographics, injury characteristics, operative course, and hospital course were analyzed. Descriptive statistics were used to examine management trends, and outcomes were compared for arterial repairs. Multivariate regression was used to evaluate surgeon specialty as a predictor of complications, readmission, vascular outcomes, and mortality.

RESULTS: A total of 231 patients met our inclusion criteria; 80% were male with a median age of 29 years. The femoral vessels were most commonly injured (39.4%), followed by the popliteal vessels (26.8%). Trauma surgeons performed the majority of femoral artery repairs (82%), while vascular surgeons repaired the majority of popliteal artery injuries (84%). Both had a similar share of brachial artery repairs (36% vs. 39%, respectively). There were no differences in complications, readmission, vascular outcomes, and mortality. Median time from arrival to operating room was significantly shorter for trauma surgeons. There was a significant downward trend between 2009 and 2017 in the proportion of total and femoral vascular procedures performed by trauma surgeons. On multivariate regression, surgical specialty was not a significant predictor of need for vascular reintervention, prophylactic or delayed fasciotomies, postoperative complications, or readmissions.

CONCLUSION: Traumas surgeons arrived quicker to the operating and had no difference in short-term clinical outcomes of brachial and femoral artery repairs compared with patients treated by vascular surgeons. Over the last decade, there has been a significant decline in the number of open vascular repairs done by trauma surgeons.

LEVEL OF EVIDENCE: Therapeutic/Care Management, Level IV.

Author List

Karam BS, Haberman K, Nguyen P, Eddine SBZ, Boyle K, Baskaran A, Figueroa J, Milia D, Carver T, Somberg L, Webb T, Davis CS, Dodgion C, Elegbede A, de Moya MA

Authors

Thomas W. Carver MD Associate Professor in the Surgery department at Medical College of Wisconsin
Christopher Stephen Davis MD, MPH Associate Professor in the Surgery department at Medical College of Wisconsin
Marc Anthony De Moya MD Chief, Professor in the Surgery department at Medical College of Wisconsin
Christopher M. Dodgion MD Associate Professor in the Surgery department at Medical College of Wisconsin
Anuoluwapo F. Elegbede MD Assistant Professor in the Surgery department at Medical College of Wisconsin
David J. Milia MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Female
Humans
Male
Popliteal Artery
Surgeons
Treatment Outcome
Vascular Surgical Procedures
Vascular System Injuries