title: Vascular surgery: An essential hospital resource in modern health care.
abstract: In modern health care, vascular surgeons frequently serve as a unique resource to other surgical specialties for vascular exposure, repair, reconstruction, or control. These services occur both in planned and unplanned clinical settings. We analyzed the frequency, outcomes, and value of vascular services in this setting to other surgical specialties and the hospital.
  
  
  
  Intraoperative planned and unplanned vascular surgery operative consultations were reviewed over a 3-year period (2013-2016). Patient demographics, requesting surgical specialty, indication and type of vascular intervention, and work relative value units generated were recorded. Univariate and multivariate analysis of factors affecting a composite outcome of in-hospital and 30-day mortality or morbidity, or both, was performed.
  
  
  
  Seventy-six vascular surgery intraoperative consultations were performed, of which 56% of the consultations were unplanned. The most common unplanned consultation was for bleeding (33%). The aorta and lower extremity were the most common vascular beds requiring vascular services. The mean work relative value units generated per vascular surgery intervention was 23.8. In-hospital and 30-day mortality was 9.2%. No difference in mortality and morbidity was found between planned and unplanned consultations. Factors associated with the composite mortality/morbidity outcome were coronary artery disease (P = .002), heart failure (P = .02), total operative blood loss (P = .009), consultation for limb ischemia (P = .013), and vascular consultation for the lower extremity (P = .01). On multivariate analysis, high operative blood loss (>5000 mL) remained significant (P = .04), and coronary artery disease approached significance (P = .06).
  
  
  
  The need for vascular surgery services is frequent, involves diverse vascular beds, and occurs commonly in an unplanned setting. When requested, vascular surgery services effectively facilitate the completion of the nonvascular procedure, even those associated with significant intraoperative blood loss. Vascular surgery services are essential to other surgical specialties and the hospital in today's modern health care environment.
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
authors.forename: Miguel F
authors.initials: MF
authors.lastname: Manzur
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
authors.forename: Sung Wan
authors.initials: SW
authors.lastname: Ham
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
authors.forename: Ramsey
authors.initials: R
authors.lastname: Elsayed
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
authors.forename: Sherwin
authors.initials: S
authors.lastname: Abdoli
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
authors.forename: Trevor
authors.initials: T
authors.lastname: Simcox
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
authors.forename: Sukgu
authors.initials: S
authors.lastname: Han
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif.
authors.forename: Vincent
authors.initials: V
authors.lastname: Rowe
authors.affiliation: Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, Calif. Electronic address: fweaver@med.usc.edu.
authors.forename: Fred A
authors.initials: FA
authors.lastname: Weaver
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000401:mortality / Q000517:prevention & control*; D002140:California; D016009:Chi-Square Distribution; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006739:Hospital Administration; D017052:Hospital Mortality; D006801:Humans; D033183:Interdisciplinary Communication; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010348:Patient Care Team / Q000458:organization & administration*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D017064:Process Assessment, Health Care / Q000458:organization & administration*; D012017:Referral and Consultation / Q000458:organization & administration; D012189:Retrospective Studies; D012307:Risk Factors; D013038:Specialization; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality / Q000458:organization & administration*