Limb salvage after complex repairs of extremity arterial injuries is independent of surgical specialty training

Steven R. Shackford, Jessica E. Kahl, Richard Y. Calvo, Meghan C. Shackford, Leigh A. Danos, James W. Davis, Gary - Vercruysse, David V. Feliciano, Ernest E. Moore, Hunter B. Moore, M. Margaret Knudson, Benjamin M. Howard, Michael J. Sise, Raul S. Coimbra, Todd W. Costantini, Scott C. Brakenridge, Gail T. Tominaga, Kathryn B. Schaffer, John T. Steele, Frank R. KennedyThomas H. Cogbill

Research output: Contribution to journalArticle

9 Citations (Scopus)

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%). Conclusion: Limb salvage following major peripheral vascular injury is independent of surgeon specialty training. The majority of complex repairs are performed by general surgeons.

Original languageEnglish (US)
Pages (from-to)716-724
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume74
Issue number3
DOIs
StatePublished - Mar 2013
Externally publishedYes

Fingerprint

Surgical Specialties
Limb Salvage
Extremities
Blood Vessels
Wounds and Injuries
Vascular System Injuries
Certification
Amputation
Length of Stay
Injury Severity Score
Surgeons
Multicenter Studies
Hospitalization
Retrospective Studies
Logistic Models
Transplants

Keywords

  • Outcome
  • Peripheral vascular trauma
  • Surgeon specialty

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Shackford, S. R., Kahl, J. E., Calvo, R. Y., Shackford, M. C., Danos, L. A., Davis, J. W., ... Cogbill, T. H. (2013). Limb salvage after complex repairs of extremity arterial injuries is independent of surgical specialty training. Journal of Trauma and Acute Care Surgery, 74(3), 716-724. https://doi.org/10.1097/TA.0b013e3182827035

Limb salvage after complex repairs of extremity arterial injuries is independent of surgical specialty training. / Shackford, Steven R.; Kahl, Jessica E.; Calvo, Richard Y.; Shackford, Meghan C.; Danos, Leigh A.; Davis, James W.; Vercruysse, Gary -; Feliciano, David V.; Moore, Ernest E.; Moore, Hunter B.; Knudson, M. Margaret; Howard, Benjamin M.; Sise, Michael J.; Coimbra, Raul S.; Costantini, Todd W.; Brakenridge, Scott C.; Tominaga, Gail T.; Schaffer, Kathryn B.; Steele, John T.; Kennedy, Frank R.; Cogbill, Thomas H.

In: Journal of Trauma and Acute Care Surgery, Vol. 74, No. 3, 03.2013, p. 716-724.

Research output: Contribution to journalArticle

Shackford, SR, Kahl, JE, Calvo, RY, Shackford, MC, Danos, LA, Davis, JW, Vercruysse, G, Feliciano, DV, Moore, EE, Moore, HB, Knudson, MM, Howard, BM, Sise, MJ, Coimbra, RS, Costantini, TW, Brakenridge, SC, Tominaga, GT, Schaffer, KB, Steele, JT, Kennedy, FR & Cogbill, TH 2013, 'Limb salvage after complex repairs of extremity arterial injuries is independent of surgical specialty training', Journal of Trauma and Acute Care Surgery, vol. 74, no. 3, pp. 716-724. https://doi.org/10.1097/TA.0b013e3182827035
Shackford, Steven R. ; Kahl, Jessica E. ; Calvo, Richard Y. ; Shackford, Meghan C. ; Danos, Leigh A. ; Davis, James W. ; Vercruysse, Gary - ; Feliciano, David V. ; Moore, Ernest E. ; Moore, Hunter B. ; Knudson, M. Margaret ; Howard, Benjamin M. ; Sise, Michael J. ; Coimbra, Raul S. ; Costantini, Todd W. ; Brakenridge, Scott C. ; Tominaga, Gail T. ; Schaffer, Kathryn B. ; Steele, John T. ; Kennedy, Frank R. ; Cogbill, Thomas H. / Limb salvage after complex repairs of extremity arterial injuries is independent of surgical specialty training. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 74, No. 3. pp. 716-724.
@article{be93552bbcca49c28623a5cc7987ec8d,
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{\%}). Conclusion: Limb salvage following major peripheral vascular injury is independent of surgeon specialty training. The majority of complex repairs are performed by general surgeons.",
keywords = "Outcome, Peripheral vascular trauma, Surgeon specialty",
author = "Shackford, {Steven R.} and Kahl, {Jessica E.} and Calvo, {Richard Y.} and Shackford, {Meghan C.} and Danos, {Leigh A.} and Davis, {James W.} and Vercruysse, {Gary -} and Feliciano, {David V.} and Moore, {Ernest E.} and Moore, {Hunter B.} and Knudson, {M. Margaret} and Howard, {Benjamin M.} and Sise, {Michael J.} and Coimbra, {Raul S.} and Costantini, {Todd W.} and Brakenridge, {Scott C.} and Tominaga, {Gail T.} and Schaffer, {Kathryn B.} and Steele, {John T.} and Kennedy, {Frank R.} and Cogbill, {Thomas H.}",
year = "2013",
month = "3",
doi = "10.1097/TA.0b013e3182827035",
language = "English (US)",
volume = "74",
pages = "716--724",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "3",

}

TY - JOUR

T1 - Limb salvage after complex repairs of extremity arterial injuries is independent of surgical specialty training

AU - Shackford, Steven R.

AU - Kahl, Jessica E.

AU - Calvo, Richard Y.

AU - Shackford, Meghan C.

AU - Danos, Leigh A.

AU - Davis, James W.

AU - Vercruysse, Gary -

AU - Feliciano, David V.

AU - Moore, Ernest E.

AU - Moore, Hunter B.

AU - Knudson, M. Margaret

AU - Howard, Benjamin M.

AU - Sise, Michael J.

AU - Coimbra, Raul S.

AU - Costantini, Todd W.

AU - Brakenridge, Scott C.

AU - Tominaga, Gail T.

AU - Schaffer, Kathryn B.

AU - Steele, John T.

AU - Kennedy, Frank R.

AU - Cogbill, Thomas H.

PY - 2013/3

Y1 - 2013/3

N2 - 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%). Conclusion: Limb salvage following major peripheral vascular injury is independent of surgeon specialty training. The majority of complex repairs are performed by general surgeons.

AB - 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%). Conclusion: Limb salvage following major peripheral vascular injury is independent of surgeon specialty training. The majority of complex repairs are performed by general surgeons.

KW - Outcome

KW - Peripheral vascular trauma

KW - Surgeon specialty

UR - http://www.scopus.com/inward/record.url?scp=84874861266&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84874861266&partnerID=8YFLogxK

U2 - 10.1097/TA.0b013e3182827035

DO - 10.1097/TA.0b013e3182827035

M3 - Article

C2 - 23425727

AN - SCOPUS:84874861266

VL - 74

SP - 716

EP - 724

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 3

ER -