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Limb salvage after complex repairs of extremity arterial injuries is independent of surgical specialty training

Shackford, Steven R. MD; Kahl, Jessica E. BA; Calvo, Richard Y. MPH; Shackford, Meghan C. BS; Danos, Leigh A. MD; Davis, James W. MD; Vercruysse, Gary A. MD; Feliciano, David V. MD; Moore, Ernest E. MD; Moore, Hunter B. MD; Knudson, M. Margaret MD; Howard, Benjamin M. MD; Sise, Michael J. MD; Coimbra, Raul S. MD; Costantini, Todd W. MD; Brakenridge, Scott C. MD; Tominaga, Gail T. MD; Schaffer, Kathryn B. MPH; Steele, John T. MD; Kennedy, Frank R. MD; Cogbill, Thomas H. MD

Journal of Trauma and Acute Care Surgery:
doi: 10.1097/TA.0b013e3182827035
CME Article
Editor's Choice
Abstract

BACKGROUND: Major peripheral vascular trauma is managed by several surgical specialties. The impact of surgical specialty training and certification on outcome has not been evaluated. We hypothesized that general surgeons without specialty training in vascular surgery would have outcomes equivalent to surgeons with vascular training in the management of extremity arterial injuries requiring interposition grafting.

METHODS: We performed a multicenter, retrospective study of patients undergoing interposition grafting for peripheral vascular injury between 1995 and 2010. Specialty was defined by training and certification. Outcomes were recorded at the time of discharge from the index hospitalization. Factors affecting limb salvage were determined using logistic regression.

RESULTS: From the 11 participating centers, 615 patients were identified. General surgeons performed 69.9%, cardiac/vascular surgeons performed 27.3%, and surgeons of other specialties performed 2.8% of the grafts. There were 32 amputations (5.2%). Outcomes did not differ by institution. Factors associated with amputation were blunt mechanism, older age, female sex, hospital length of stay, and Injury Severity Score (ISS). There was no significant difference in limb salvage among specialty groups (general surgeons, 94%; cardiac/vascular, 95%; other, 100%).

CONCLUSION: Limb salvage following major peripheral vascular injury is independent of surgeon specialty training. The majority of complex repairs are performed by general surgeons.

LEVEL OF EVIDENCE: Therapeutic/care management, level III.

Author Information

From the Scripps Mercy Hospital (S.R.S., J.E.K., R.Y.C., M.C.S., M.J.S.); University of California San Diego Medical Center (R.S.C., T.W.C.); and Sharp Memorial Hospital (F.R.K.), San Diego; University of California San Francisco/Fresno (L.A.D., J.W.D.), Fresno; San Francisco General Hospital (M.M.K., B.M.H.), San Francisco; Scripps Memorial Hospital La Jolla (G.T.T., K.B.S.), La Jolla; and Palomar Medical Center (J.T.S.), Escondido, California; Grady Memorial Hospital (G.A.V., D.V.F.), Emory University, Atlanta, Georgia; Denver Health Medical Center (E.E.M., H.B.M.), Denver, Colorado; Harborview Medical Center (S.C.B.), Seattle, Washingotn; and Gundersen Lutheran Medical Center (T.H.C.), La Cross, Wisconsin.

Submitted: August 27, 2012, Revised: November 30, 2012, Accepted: November 30, 2012.

This study was presented at the 71st American Association for the Surgery of Trauma Annual Meeting, September 12–15, 2012, in Kauai, Hawaii.

Address for reprints: Steven R. Shackford, MD, Trauma Service (MER 62), Scripps Mercy Hospital, 550 Washington St, Suite 641, San Diego, CA 92103; email: shackford.steven@scrippshealth.org.

© 2013 Lippincott Williams & Wilkins, Inc.