Inpatient consultations with the vascular and endovascular surgery team at an academic tertiary hospital

Raymundo, Daniel Urban; Dalio, Marcelo Bellini; Ribeiro, Mauricio Serra; Joviliano, Edwaldo Edner

doi:10.1590/1677-5449.20210159

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ORIGINAL ARTICLE • J. Vasc. Bras. 21 • 2022 • https://doi.org/10.1590/1677-5449.20210159 linkcopy

Inpatient consultations with the vascular and endovascular surgery team at an academic tertiary hospital

Interconsultas realizadas pela equipe de cirurgia vascular e endovascular em um hospital universitário terciário

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Background Inpatient consultations are a fundamental component of practice in tertiary care centers. However, such consultations demand resources, generating a significant workload.

Objectives To investigate the profile of inpatient consultations requested by other specialties and provided by the Vascular and Endovascular Surgery team at an academic tertiary hospital.

Methods Prospective observational study.

Results From May 2017 to May 2018, 223 consultations were provided, representing 2.2% of the workload. Most consultations were requested by Oncology (16.6%), Hematology (9.9%), Nephrology (9.0%), and Cardiology (6.3%). The leading reasons for inpatient consultation were: need for vascular access (51.1%) and requests to evaluate a vascular disease (48.9%). Acute venous diseases accounted for 19.3% of consultations, chronic arterial diseases for 14.8%, acute arterial diseases for 7.2%, diabetic feet for 5.4%, and chronic venous diseases accounted for 2.2%. Surgical treatment was performed in 57.0%, either conventional (43.9%) or endovascular (13.0%). Almost all (98.2%) patients’ issues were resolved.

Conclusions Inpatient consultations with the Vascular and Endovascular Surgery team in a tertiary academic hospital accounted for 2.2% of the team’s entire workload. Most patients were elective and underwent low-complexity elective surgical procedures. There may be an opportunity to improve healthcare, redirecting these patients to the outpatient flow.

Keywords:
inpatients; consultations; vascular; endovascular; surgery; tertiary; hospital; care; healthcare

Source specialty	n=223	95% CI *
Oncology	37 (16.6%)	12.25-22.06
Hematology	22 (9.9%)	6.55-14.54
Nephrology	20 (9.0%)	5.82-13.51
Cardiology	14 (6.3%)	3.69-10.34
Nutrition and Dietetics	10 (4.5%)	2.35-8.16
Infectious Diseases	9 (4.0%)	2.03-7.60
General Surgery	9 (4.0%)	2.03-7.60
Endocrinology	8 (3.6%)	1.71-7.03
Obstetrics & Gynecology	8 (3.6%)	1.71-7.03
Orthopedics	8 (3.6%)	1.71-7.03
Adult Intensive Care	7(3.1%)	1.40-6.46
Dermatology	6 (2.7%)	1.10-5.88
Immunology	6 (2.7%)	1.10-5.88
Proctology	6 (2.7%)	1.10-5.88
Internal Medicine	5 (2.2%)	0.81-5.29
Neurology	5 (2.2%)	0.81-5.29
Cardiac surgery	4 (1.8%)	0.54-4.68
Urology	4 (1.8%)	0.54-4.68
Gastroenterology	3 (1.3%)	0.27-4.06
Pediatrics	3 (1.3%)	0.27-4.06
Pneumology	3 (1.3%)	0.27-4.06
Mastology	3 (1.3%)	0.27-4.06
Geriatrics	2 (0.9%)	0.03-3.42
Neonatology	2 (0.9%)	0.03-3.42
Pediatric Intensive Care	2 (0.9%)	0.03-3.42
Head and Neck Surgery	2 (0.9%)	0.03-3.42
Interventional Radiology	2 (0.9%)	0.03-3.42
Other	13 (5.8%)	3.35-9.80

Urgency
Elective	162 (72.6%)	66.44-78.09
Urgent	56 (25.1%)	19.86-31.21
Emergent	5 (2.2%)	0.81-5.29

Reason for the consultation
Need for vascular access	114 (51.1%)	44.60-57.61
Elective chemotherapy long-term catheter	83 (37.2%)	31.14-43.73
Elective vascular access for hemodialysis	18 (8.1%)	5.10-12.46
Urgent vascular access	13 (5.8%)	3.35-9.80
Vascular diseases	109 (48.9%)	42.39-55.40
Acute venous diseases	43 (19.3%)	14.62-24.99
Chronic arterial diseases	33 (14.8%)	10.70-20.09
Acute arterial diseases	16 (7.2%)	4.39-11.41
Acute limb ischemia	14 (6.3%)	3.69-10.34
Ruptured aortic aneurysms	2 (0.9%)	0.03-3.42
Diabetic foot	12 (5.4%)	3.01-9.26
Chronic venous diseases	5 (2.2%)	0.81-5.29

Treatment
Surgical	127 (57%)	50.39-63.28
Conventional	98 (43.9%)	37.59-50.51
Endovascular	29 (13.0%)	9.17-18.10
Medical	96 (43.0%)	36.72-49.61

Outcome
Resolution	219 (98.2%)	95.32-99.46
Clinical deterioration	1 (0.4%)	0.01-2.75
Death	3 (1.3%)	0.27-4.06

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Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV) Rua Estela, 515, bloco E, conj. 21, Vila Mariana, CEP04011-002 - São Paulo, SP, Tel.: (11) 5084.3482 / 5084.2853 - Porto Alegre - RS - Brazil
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[TFN1] ^*
95% CI = 95% confidence interval, obtained by the Wald method.