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Published on: May 26, 2023
Rise in Percutaneous Vascular Procedures and Extracorporeal Membrane Oxygenation Is Associated With Increase in
Daniel Silverberg1, Haitam Hater1, Moshe Halak1
1The Department of Vascular Surgery, 26744The Chaim Sheba Medical Center, Tel Hashomer, The Sackler School of Medicine, Tel Aviv, Israel.
Insights
Emergent vascular surgery cases are increasing, driven by procedures from interventional cardiology, radiology, and ECMO. This trend significantly impacts vascular surgeons' workload, requiring proactive resource planning.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Interventional Radiology
Background:
- Vascular surgeon workload is influenced by procedures from other hospital departments.
- Evaluating trends in emergent vascular surgery is crucial for resource management.
Purpose of the Study:
- To assess the 5-year trend of emergent vascular surgery procedures.
- To categorize these procedures by operative type.
- To correlate trends with activities in related departments.
Main Methods:
- Retrospective review of emergent surgical operations (2017-2021).
- Data collection on emergent vascular surgeries and procedures from interventional cardiology, interventional radiology, neurointerventional radiology, and ECMO.
- Analysis of procedural trends and correlations.
Main Results:
- Total of 1783 procedures, with 485 (27%) emergent cases.
- Significant increase in emergent procedures from 22% to 34% (56% rise, P<.01).
- Rise in iatrogenic vascular repairs (38%) linked to increased interventional cardiology, IR/NIR, and ECMO activity (15%, 31%, 300% increases).
Conclusions:
- Increasing endovascular procedures by non-vascular services correlate with a rise in emergent vascular surgeries.
- Anticipated growth in these procedures and specialized units (stroke, ECMO) will increase vascular surgery workload.
- Healthcare centers must prepare for increased demand on vascular surgery to manage associated complications.
Abstract:
Background: The workload of vascular surgeons is widely affected by the procedural activity of other departments within the same medical center. The purpose of this study was to evaluate the trend in emergent vascular surgery procedures over a 5 year period in a tertiary referral hospital and categorize these procedures based on the nature of the operative procedure required. Methods: A single center, retrospective review of all emergent surgical operations performed at our tertiary referral hospital between the years 2017-2021. Data collected included types of emergent vascular surgery performed, in addition to procedures performed by the departments of interventional cardiology (IC), interventional radiology (IR), neurointerventional radiology (NIR) and extracorporeal membrane oxygenation (ECMO) at our institution. Results: During the study period were performed a total of 1783 operative procedures (mean 356 ± 26/year). Of those, 485 (27%) were emergent cases. We observed a gradual increase in emergent operative procedures performed from 2017 to 2021 (22% to 34% of all cases, increase of 56%, P<.01). A striking increase was seen with vascular repairs performed for iatrogenic vascular injuries secondary to arterial access complications (47% to 65% of all iatrogenic vascular injuries, increase of 38%). The increase correlated with an increase in activity seen in the departments of IC, IR/NIR and ECMO (15%, 31% and 300%, respectively). Conclusions: An increasing number of emergent surgical procedures performed by our vascular surgery department correlates with the increasing number of endovascular procedures performed by non- vascular services. As these procedures are expected to increase, together with the number of stroke units and ECMO units being created, medical centers must be aware that these may result in a significant increase in the workload of the vascular surgery department in order to deal with complications associated with these procedures.
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