Case Log for Liver Resections

[ejs064]

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I did 2 liver resections recently, and realized that I've coded these on my ACGME case log as "major vascular" before. This seems legit, as the surgeon nicked the hepatic vein and lost a few hundred of blood very quickly. In my experience, this is not uncommon.

Do you guys log these as major vascular cases? The ACGME says the following about major vascular:

"20 patients undergoing open or endovascular procedures on major vessels, including carotid surgery, intrathoracic vascular surgery, intra- abdominal vascular surgery, or peripheral vascular surgery. Excluded from this category is surgery for vascular access or repair of vascular access"

(from ACGME requirements, page 15)

 

[SexPanther]

I did 2 liver resections recently, and realized that I've coded these on my ACGME case log as "major vascular" before. This seems legit, as the surgeon nicked the hepatic vein and lost a few hundred of blood very quickly. In my experience, this is not uncommon.

Do you guys log these as major vascular cases? The ACGME says the following about major vascular:

"20 patients undergoing open or endovascular procedures on major vessels, including carotid surgery, intrathoracic vascular surgery, intra- abdominal vascular surgery, or peripheral vascular surgery. Excluded from this category is surgery for vascular access or repair of vascular access"

(from ACGME requirements, page 15)

Yes, I log them as major vascular surgery as do most of my classmates.

 

[periopdoc]

As a resident I was required to submit cumulative numbers each year as opposed to tracking specific cases online. I kept a personal log (HIPPA compliant of course), and I did not count segmental liver resections as major vascular. I did count liver transplants if we clamped the IVC entirely (pretty rare as they mostly did partial exclusion with a side-biting clamp).

It seems that segmental resections involving segment 1 would be legit given the proximity to the IVC. Beyond that, the amount of vascular injury is highly surgeon dependent. One surgeon I worked with was very good and I would take patients back with a 20g piv. Another surgeon was a bit different. I always had an a-line and 2 big IVs. Sometimes an introducer.

All in all, I think it is legitimate, as long as the significant majority of your cases are real major vascular. I was lucky enough to have enough thoracic vascular in my residency that I didn't need to count the liver transplants or even the Open or endovascular AAA cases to get my numbers. Of course I did count them in the final tally.

-pod

 

[cchoukal]

This is a great question for your program director. They're supposed to know this stuff cold.

 

[periopdoc]

This is a great question for your program director. They're supposed to know this stuff cold.

Of course the answer you will get from your program director may vary sigmificantly from the answer you get from other program directors. I suspect those with minimal real major vascular will be more liberal with their definition of major vascular. Thus a good question to get the pulse of how everyone else is doing it, presumably after input from their PD.

-pod