American Surgical Association

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A Surgical Endovascular Trauma Service Increases Case Volume And Decreases Time To Hemostasis
Jonathan J. Morrison*, Marta J. Madurska*, Anna N. Romagnoli*, Marcus Ottochian*, Sakib N. Adnan*, Tiffany Kuebler*, William Teeter*, Melanie R. Hoehn*, Megan L. Brenner*, Joseph J. DuBose*, Thomas M. Scalea
R Adams Cowley Shock Trauma Center, Baltimore, MD

OBJECTIVE(S):
Endovascular techniques are vital for trauma care, but timely access can be a challenge. In 2015, we developed a surgeon staffed endovascular trauma service (ETS) to complement the existing interventional radiology (IR) service. We evaluated the impact of the ETS on case volume and time to hemostasis. METHODS:
The electronic medical record of trauma patients undergoing endovascular procedures between 2013 and 2018 were queried for provider type (IR or ETS). Case volume and rates were expressed per 100 monthly admissions, normalizing for seasonal variation. Interrupted time series analysis was used to model the case rate pre- and post-introduction of the ETS. Admission-to-procedure-time data was collected for pelvic angioembolization as a marker of patients requiring emergency hemostasis. RESULTS:
Over 6 years, 1390 patients underwent endovascular procedures. Overall case volume increased from 3.84-4.78 at a rate 0.1 (p=0.002) after introduction of the ETS. IR case volume decreased from 3.84-2.19 at a rate of 0.03 (p=0.063). ETS case volume increased at a rate 0.72 (p=0.002), which was significantly different from the IR trend (p<0.001). Median [IQR] time-to-procedure (hours) was significantly shorter for pelvic angioembolization (3.2 [6.5] vs. 6.5 [3.4]; p<0.001), when ETS was compared to IR. CONCLUSIONS:
A surgical ETS increases case volume and decreases time to hemostasis for trauma patients requiring time sensitive interventions. Further work is required to assess patient outcome following this change.

* By Invitation


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