VESS06 - Comparative Outcomes of Extremity Vascular Trauma Managed in Trauma vs. Vascular Hybrid Operating Rooms

Objectives: Timely hemorrhage control and revascularization are critical for limb salvage and survival in extremity vascular trauma. Consequently, practice guidelines increasingly advocate for the establishment of dedicated trauma hybrid operating rooms (tORs) with fluoroscopic capabilities. However, the impact of tORs on outcomes in extremity vascular trauma compared to vascular hybrid operating rooms (vORs) remains unclear. This study evaluates our institutional experience managing extremity vascular trauma in tORs versus vORs.

Methods: Our institution established a dedicated tOR in October 2016. Subsequently, three vORs were introduced in November 2017 for elective and emergency vascular cases. Between October 2016 and June 2023, 610 adult patients with extremity vascular injuries were identified from a trauma registry using ICD-10 codes. Primary outcomes included mortality and major adverse limb events (MALE) i.e. patency loss, reintervention and major limb amputation. Univariate analyses were performed using the Wilcoxon Two-Sample nonparametric test for continuous variables and Fisher’s Exact test for categorical variables.

Results: Fifty-seven patients underwent interventions in hybrid ORs, with 28 treated in the tOR and 29 in vORs (Table I). tOR patients had significantly greater injury severity scores (32.5 [25.0, 41.8] vs. 16.0 [16.0, 25.0], p< 0.001) and physiologic derangement (lactate: 3.7 [2.3, 5.8] vs. 1.7 [1.1, 3.2]p=0.001; base excess: -4.5 [-11.3, -1.3] vs. 0.0 [-3.0, 2.0]p < 0.001). The tOR cohort experienced more torso trauma and required combined trauma and vascular surgical intervention more frequently (50.0% vs. 0.0%, p< 0.001). Patients in the tOR lost more blood (500.0 mL [200.0, 1000.0] vs. 200.0 mL [100.0, 675.0], p=0.023) and received more transfusions (6.0 units [0.0, 14.8] vs. 0.0 units [0.0, 3.5]p=0.009).

Despite these complexities, tOR patients arrived in the OR quicker (132.5 min [73.8, 204.5] vs. 300.0min [180.0, 1050.0], p< 0.001) and achieved revascularization faster (345.0 min [257.5, 570.0] vs. 660.0min [354.0, 1330.0], p< 0.001). There were no significant differences in in-hospital mortality (7.1% vs. 3.5%, p=0.612), overall mortality (7.7% vs. 3.6%, p=0.604), or MALE at 30 days (15.4% vs. 14.3%, p=1.0) or 1 year (23.1% vs. 17.9%, p=0.741). Costs were also comparable between the two settings ($2,699.0 [$1,222.8, $6,681.8] vs. $1,402.0 [$759.0, $4,976.5], p=0.159).

Conclusions: Patients with extremity vascular trauma treated in the tOR presented with higher acuity and injury complexity, often requiring multidisciplinary intervention. Despite these challenges, tOR utilization expedited time to intervention and revascularization compared to vORs. Mortality and limb salvage outcomes were excellent across both settings, underscoring the effectiveness of hybrid OR capabilities in managing extremity vascular trauma.