Planned Versus Intraoperative Vascular Surgery Consultations in Orthopedic Oncology

Orthopedic oncology surgeries frequently involve complex resections where critical neurovascular structures are at risk, and vascular injury can result in severe complications, including functional loss and mortality. Although multidisciplinary vascular collaboration is increasingly recognized as beneficial in oncologic surgery, limited evidence exists regarding optimal timing of vascular surgery consultation in orthopedic oncology. This study evaluated whether preoperative planned consultations improve intraoperative and postoperative outcomes compared to intraoperative consultations.

A retrospective review identified 30 patients who underwent orthopedic oncology surgery requiring vascular surgery involvement between 2015 and 2025 at a single academic institution. Patients were categorized into planned vascular consultations (n = 18) and intraoperative consultations (n = 12). Data collection included demographics, operative details, estimated blood loss (EBL), complications, and type of vascular intervention.

The intra-operative consultation group experienced significantly higher median EBL (1,225 mL vs 325 mL, P = .015). Additionally, intraoperative consultations demonstrated trends toward longer operative times (307 vs 185.5 minutes) and higher postoperative complication rates. Infections occurred in 42% of intraoperative cases compared to 17% of planned cases. One intraoperative patient also experienced cardiac arrest, and another developed deep vein thrombosis.

Planned vascular surgery consultations are associated with significantly reduced intraoperative blood loss and trend toward improved operative efficiency and fewer postoperative complications. This is the first study directly comparing outcomes between planned and intraoperative vascular consultations in orthopedic oncology. Early vascular involvement enables better anticipation of vascular challenges and supports proactive multidisciplinary collaboration to enhance patient safety and optimize resource use.