title: Limb salvage after complex repairs of extremity arterial injuries is independent of surgical specialty training.
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%).
  
  
  CONCLUSIONS
  Limb salvage following major peripheral vascular injury is independent of surgeon specialty training. The majority of complex repairs are performed by general surgeons.
  
  
  METHODS
  Therapeutic/care management, level III.
authors: Scripps Mercy Hospital, San Diego, California 92103, USA. shackford.steven@scrippshealth.org
authors: Steven R
authors: SR
authors: Shackford
authors: Jessica E
authors: JE
authors: Kahl
authors: Richard Y
authors: RY
authors: Calvo
authors: Meghan C
authors: MC
authors: Shackford
authors: Leigh A
authors: LA
authors: Danos
authors: James W
authors: JW
authors: Davis
authors: Gary A
authors: GA
authors: Vercruysse
authors: David V
authors: DV
authors: Feliciano
authors: Ernest E
authors: EE
authors: Moore
authors: Hunter B
authors: HB
authors: Moore
authors: M Margaret
authors: MM
authors: Knudson
authors: Benjamin M
authors: BM
authors: Howard
authors: Michael J
authors: MJ
authors: Sise
authors: Raul S
authors: RS
authors: Coimbra
authors: Todd W
authors: TW
authors: Costantini
authors: Scott C
authors: SC
authors: Brakenridge
authors: Gail T
authors: GT
authors: Tominaga
authors: Kathryn B
authors: KB
authors: Schaffer
authors: John T
authors: JT
authors: Steele
authors: Frank R
authors: FR
authors: Kennedy
authors: Thomas H
authors: TH
authors: Cogbill
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D001158:Arteries / Q000293:injuries* / Q000601:surgery; D004502:Education, Medical, Continuing / Q000379:methods*; D005121:Extremities / Q000098:blood supply / Q000293:injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D023821:Limb Salvage / Q000193:education* / Q000379:methods; D008297:Male; D012189:Retrospective Studies; D014193:Trauma Centers; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000193:education* / Q000379:methods; D057772:Vascular System Injuries / Q000175:diagnosis / Q000601:surgery*