The value of vascular surgeons in modern health care systems: A systematic review and meta-analysis

IF 3.9 2区医学 Q1 PERIPHERAL VASCULAR DISEASE

Journal of Vascular Surgery Pub Date : 2026-03-01 Epub Date: 2025-10-28 DOI:10.1016/j.jvs.2025.07.062

Luis Morales Ojeda MD , Stefania Montero Arcila MD , Victor Andrade Nunes MD , Cristiano Marciano Duarte BA , Melina Papi MD , Donald L. Jacobs MD, MSC , Emily A. Malgor MD , Rafael D. Malgor MD, MBA

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引用次数: 0

Abstract

Background

Vascular surgeons are crucial in modern health care, offering indispensable support across surgical services. Despite their clinical and economic contributions, their full value often goes unrecognized. This systematic review and meta-analysis aimed to assess the interdisciplinary and financial impact of vascular surgeons within contemporary health care systems.

Methods

A systematic search was conducted in August 2024 across MEDLINE, PubMed, the Cochrane Vascular Registers, and other databases. The studies included randomized controlled trials, cohort studies, and economic evaluations published from 2010 onward. Dual reviewer screening and data extraction followed PRISMA guidelines, and the study protocol was registered with PROSPERO (CRD42024589273). Quality assessment was performed using the Newcastle-Ottawa scale. Meta-analyses employed random effects models, with heterogeneity assessed via I² and Cochran's Q tests.

Results

Of 3031 screened records, 29 studies involving 6557 patients met the inclusion criteria. Vascular surgery consultations were most frequently requested by emergency medicine (15.3%), orthopedics (14.1%), trauma (12.2%), and neurosurgery (10.1%). Hemorrhage control (16.4%) and ischemia (14.1%) were the primary reasons for consultations. Vascular surgeons performed 928 procedures, predominantly primary repairs (49.2%) and graft placements (17.7%). Multidisciplinary collaboration, particularly in surgical oncology and podiatry, significantly improved outcomes, including revascularization success in cases of acute limb ischemia and intraoperative arterial injuries (94%), decreased amputation rates, and enhanced margin-negative resections. Financial analyses revealed that vascular surgery contributes substantial work relative value units (wRVUs) and revenue, with some services generating >$130 million over 5 years. Meta-analysis identified pooled consultation proportions of 22% among urology, orthopedics, and general surgery, with significant heterogeneity (I² = 98.7%). Meta-regression confirmed consultation volume as a significant predictor of pooled effect size.

Conclusions

Vascular surgeons play a crucial role in interdisciplinary health care and are a valuable financial resource in medical services. Their participation improves surgical results, decreases complications, and enhances hospital profitability. It is essential to strategically incorporate and acknowledge vascular surgery within multidisciplinary teams and institutional planning to optimize patient care, revenue generation, and system efficiency.

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血管外科医生在现代医疗保健系统中的价值：系统回顾和荟萃分析。

背景：血管外科医生在现代医疗保健中至关重要，在外科服务中提供不可或缺的支持。尽管他们的临床和经济贡献，他们的全部价值往往没有得到承认。本系统综述和荟萃分析旨在评估血管外科医生在当代医疗保健系统中的跨学科和财务影响。方法：于2024年8月在MEDLINE、PubMed、Cochrane Vascular Registers等数据库中进行系统检索。这些研究包括随机对照试验、队列研究和2010年以后发表的经济评估。双审稿人筛选和数据提取遵循PRISMA指南，研究方案已在PROSPERO注册（CRD42024589273）。使用纽卡斯尔-渥太华量表进行质量评估。meta分析采用随机效应模型，通过I2和Cochran’s Q检验评估异质性。结果：在3031项筛选记录中，29项研究涉及6557例患者符合纳入标准。急诊内科（15.3%）、骨科（14.1%）、创伤科（12.2%）和神经外科（10.1%）最常要求进行血管外科咨询。出血控制（16.4%）和缺血（14.1%）是就诊的主要原因。血管外科医生进行了928例手术，主要是初级修复（49.2%）和移植物放置（17.7%）。多学科合作，特别是在外科肿瘤学和足病方面，显著改善了结果，包括急性肢体缺血和术中动脉损伤的血运重建成功率（94%），截肢率降低，边缘阴性切除率提高。财务分析显示，血管手术贡献了大量的工作相对价值单位（wRVUs）和收入，一些服务在五年内创造了超过1.3亿美元的收入。荟萃分析发现泌尿外科、骨科和普外科的合并会诊比例为22%，存在显著的异质性（I2 = 98.7%）。meta回归证实咨询量是综合效应大小的重要预测因子。结论：血管外科医生在跨学科医疗保健中发挥着至关重要的作用，是医疗服务中宝贵的经济资源。他们的参与改善了手术效果，减少了并发症，提高了医院的盈利能力。战略性地将血管外科纳入多学科团队和机构规划中，以优化患者护理、创收和系统效率是至关重要的。

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来源期刊

Journal of Vascular Surgery 医学-外科

CiteScore

7.70

自引率

18.60%

发文量

1469

审稿时长

54 days

期刊介绍： Journal of Vascular Surgery ® aims to be the premier international journal of medical, endovascular and surgical care of vascular diseases. It is dedicated to the science and art of vascular surgery and aims to improve the management of patients with vascular diseases by publishing relevant papers that report important medical advances, test new hypotheses, and address current controversies. To acheive this goal, the Journal will publish original clinical and laboratory studies, and reports and papers that comment on the social, economic, ethical, legal, and political factors, which relate to these aims. As the official publication of The Society for Vascular Surgery, the Journal will publish, after peer review, selected papers presented at the annual meeting of this organization and affiliated vascular societies, as well as original articles from members and non-members.