Defining the burden, scope, and future of vascular acute care surgery

Harris, Donald G.; Herrera, Anthony V.; Drucker, Charles B.; Kalsi, Richa; Menon, Nandakumar; Toursavadkohi, Shahab; Diaz, José J.; Crawford, Robert S.

doi:10.1016/j.jvs.2017.04.060

Cited by 13 publications

(8 citation statements)

References 37 publications

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“…In our study, 148 patients (78.3%) underwent an acute vascular procedure and 41 patients (21.69%) with an elective vascular procedure. In Harris's study, there was 67% of acute vascular procedure and 33% of an elective surgery [20]. The high rate of an acute vascular procedures in our study could be explained by the reason of admission.…”

Section: Discussionmentioning

confidence: 38%

Vascular Surgery of Limbs in Antananarivo: Indications and Outcomes

Zl.¹,

Rajaobelison²,

Hf³

et al. 2022

PJMHS

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Background : The aim of this study was to describe the indications and outcomes for vascular surgery of limbs in Antananarivo. Methods: This was a retrospective and descriptive study for a period of 6 years (01 January 2015 to 31 December 2020), performed at Joseph Ravoahangy Andrianavalona Teaching Hospital Antananarivo, including all patients underwent arterial procedures of limbs. Demographic data, surgical indications, cardiovascular risk factors and history of cardiovascular disease, reason of admission, diagnostic imaging, surgical procedures and outcomes were analyzed. Results : One hundred eighty-nine patients were recorded, including 141 males (74.60%) and 48 women (25.39%). The average age was 48.27years old. The commonest indications of surgical vascular procedures were trauma (33.86%), diabetic peripheral arteriopathy (38.09%) and peripheral arterial disease (12.16%). The most common modifiable risk factors for cardiovascular disease were diabetes mellitus (53.43%), high blood pressure (51.85%), smoking (33.86%). Fourty-one patients (21.69%) had a history of cardiovascular disease. Gangrene (46.03%) and external bleeding (32.27%) were the commonest reason of admission. Surgical procedures were amputation (51.85%), arterial repair (32.80%), Fogarty thromboembolectomy (8.99%), ligation (13.15%) and popliteal cyst excision (3.17%). All revascularization procedures were performed by an open surgery. The overall limb salvage rate was 96.82%. Conclusion: Trauma and diabetic peripheral arteriopathy were the commonest indication of vascular surgery of limbs. Open repair surgery remain the surgical procedure to perform vascular surgery of limbs in our context. Keywords: Peripheral arterial. Trauma. Gangrene. Amputation. Revascularization. Surgery

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Section: Discussionmentioning

confidence: 38%

Vascular Surgery of Limbs in Antananarivo: Indications and Outcomes

Zl.¹,

Rajaobelison²,

Hf³

et al. 2022

PJMHS

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“…Causation with any intervention independent of the others cannot be determined, however. As we have previously proposed, in Medical Centers such as ours, with a high preponderance of nonelective vascular surgery, specific management, training, and resource capabilities may further reduce ALOS and increase hospital profitability [9]. To our knowledge, no similar group of interventions has been documented in a similar vascular surgery population.…”

Section: Discussionmentioning

confidence: 68%

“…In general surgery, this resulted in the birth of acute care surgery as a unique specialty. This work, and others by our group [9,30], highlight that a team dedicated to caring for patients with acute vascular diseases that demand intense resource utilization can optimize outcomes, achieve efficiency, and contain costs. It is not unreasonable to think this model will continue to sprout at high volume/high acuity centers and evolve into its own academic practice and identity, mirroring what has occurred in general surgery.…”

Section: Discussionmentioning

confidence: 83%

Reduced length of stay and 30-day readmission rate on an inpatient vascular surgery service

Aicher

Hanlon

Rosenberger

et al. 2019

Journal of Vascular Nursing

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Background: As the cost of care for patients with specific diagnoses becomes fixed, hospitals must develop systems to reduce length of stay and optimize the utilization of hospital resources while maintaining a high quality of care. The goal of this study is to evaluate the implementation and efficacy of a system designed to reduce average length of stay on a vascular surgery service. Study Design: To effectively reduce our average length of stay we restructured patient rounds, implemented multidisciplinary rounds, introduced clinical pathways to post-operative care, and expanded outpatient management of post-operative patients. 1697 adult vascular surgery patients discharged while under the medical direction of a vascular surgeon between 7/1/2013 and 6/30/2016 were included in the study. Results: Improving communication with critical staff and utilizing procedural space outside of the main operating rooms led to a 2.8-day reduction in length of stay (10.8 vs 8.0, P < 0.001). There was a trend toward a reduction in 30-day readmission rate (12% vs. 10%, respectively; P = 0.01) and no significant difference in case-mix index as a measure of illness severity (2.5 vs. 2.4, respectively; P = 0.15). Length of stay reductions were heterogeneous among the types of vascular disease studied, with greater improvements seen in patients undergoing lower extremity amputation, lower extremity angiogram, and endovascular aneurysm repair for non-ruptured abdominal aortic aneurysm. Less pronounced differences were observed in patients undergoing carotid artery endarterectomy/stenting and lower extremity bypasses. Conclusions: Restructuring team rounds and instituting a multidisciplinary approach to discharge planning produced significant reductions in length of stay without a deleterious effect on patient care that may impact hospital profitability.

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“…In such patients, an endovascular approach was often excluded due to anatomical criteria and an open surgery was preferred, justifying our increased rate of open surgery procedures and the longer hospital stay. The significant improvement of urgent/emergent interventions due to delayed diagnosis and treatment, together with the increased rate of critically illness patients, that used hospital care only if necessary and awaited the onset of later stages of disease, has been well described in other clinical experiences [17][18] .…”

Section: Discussionmentioning

confidence: 99%