Intraoperative Consultations to Acute Care Surgery at a Level I Trauma Center

Intraoperative consultations are an important component of acute care surgery (ACS). The nature of these consultations is incompletely characterized by the existing literature. The study objective was to define the characteristics of intraoperative consults managed by a mature ACS program at a Level I trauma center. All intraoperative consultations requested from the ACS service at LAC+USC Medical Center (January 2011-July 2016) were identified. Demographics, date/time of consultation, referring service, procedure data, and outcomes were abstracted. Sixty-four intraoperative consultations were identified. Patients had a mean age of 45 (range 21-64) and 84 per cent (n = 54) were female. Gynecology was the most frequent consulting service (n = 42, 66%), followed by urology (n = 12, 19%). Surgical intervention was required in 61 per cent (n = 39) and verbal advice with clinical follow-up was required in 39 per cent (n = 25). The most common procedures were repair of an injury (n = 19, 49%), usually to the small bowel or colon; resection of an incidental finding (n = 13, 33%), typically the appendix or a Meckel's diverticulum; and lysis of adhesions (n = 7, 18%). In conclusion, intraoperative consultation is provided by ACS to a wide range of consultants, especially gynecology and urology. These consults are most frequently requested for concern for iatrogenic injury. Both surgical and verbal interventions are used.