Zsolt Stockinger, MD, Caryn Turner, MPH, Jennifer Gurney, MD. Joint Trauma System
Objectives: Thoracic surgery constitutes 2.5% of surgical procedures performed in theater, but these are increasingly foreign to military surgeons. This study examines thoracic surgical workload in Iraq and Afghanistan to help define surgical training gaps.
Methods: Retrospective analysis of Department of Defense Trauma Registry (DoDTR) for all Role 2 (forward surgical) and Role 3 (theater) military treatment facilities (MTFs), from January 2002 to May 2016. The 91 thoracic surgical ICD-9-CM procedure codes were grouped into ten categories based on anatomy or endoscopy. Select groups were further stratified by type of definitive procedure. Procedure groupings were determined and adjudicated by surgeon subject matter experts. Analysis used Stata Version 14 (College Station, Texas).
Results: A total of 5,365 thoracic surgical procedures were identified in the data set. The majority of procedures (4,709, 87%) were performed at Role 3 MTFs. The thoracic surgical procedures groups with the largest proportions were: Bronchoscopy (38.7%), Thoracotomy (16.5%), Diaphragm (15.4%), and Lung (11.2%). Nearly 53% of esophageal procedures were repairs; 29% of lung procedures were segmentectomies; 15% of thoracotomies were coded specifically as ED thoracotomies; and 88% of vascular procedures were ligation. Thoracic workload was variable over the 15 year study period.
| Role 2 N (%) | Role 3 N (%) | Total N (%) | |
|---|---|---|---|
| Bronchoscopy | 54 (8.2) | 2,021 (42.9) | 2,075 (38.7) |
| Bronchus | 1 (0.2) | 16 (0.3) | 17 (0.3) |
| Cardiac | 84 (12.8) | 342 (7.3) | 426 (7.9) |
| Diaphragm | 185 (28.2) | 641 (13.6) | 826 (15.4) |
| Esophagus | 1 (0.2) | 39 (0.8) | 40 (0.8) |
| Lung | 104 (15.8) | 499 (10.6) | 603 (11.2) |
| Thoracoscopy | 0 (0) | 22 (0.5) | 22 (0.4) |
| Thoracotomy | 135 (20.6) | 753 (16) | 888 (16.5) |
| Vascular | 66 (10.1) | 223 (4.7) | 289 (5.4) |
| Other | 26 (4) | 153 (3.3) | 179 (3.3) |
| Total | 656 (100) | 4,709 (100) | 5,365 (100) |
Conclusions: With the exception of Bronchoscopy, Role 2 and Role 3 reported the same top procedures. Thoracic surgical skill sets remain extremely relevant to the deployed military surgeon, and pose a training and sustainment challenge for the general surgeon.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86237
Program Number: MSS09
Presentation Session: Full-Day Military Surgical Symposium – Trauma/Critical Care Presentations
Presentation Type: MSSPodium