Jordan Guice, MD, MPH1, Jennifer Gurney, MD2, Deborah Del Junco, PhD2, Stacy Shackelford, MD2, Tyson Becker, MD1. 1SAMMC, 2USAISR
Background: Deployed general surgeons provide emergency surgery for combat casualties. Often, general surgeons are performing neurosurgical procedures (crainectomy, crainotomy, and Burr hole), which in civilian settings are normally performed by neurosurgeons. A survey was conducted to assess general surgeons’ experience with emergency neurosurgical procedures in the deployed setting, pre-deployment training, use of neurosurgical teleconsultation, comfort level with performing emergency neurosurgical procedures and recommendations for skill enhancement.
Methods: A detailed, voluntary and anonymous online survey was made available to military surgeons asking about surgical training, deployment experience, pre-deployment training, comfort and preparedness with neurosurgical deployment-relevant skills. Responses were summarized with descriptive statistics. Multiple logistic modeling was used to identify variables independently associated with a high level of comfort and with the actual performance of a neurosurgical procedure. Data were analyzed using SAS 9.4 and Stata Corp 14.0.
Results: 226 responses were included, representing over 400 separate deployments. Forty-three respondents (19.0%) reported having performed at least one crainectomy, craniotomy, or Burr hole in the deployed setting. Neurosurgeon teleconsultation was utilized by 13 respondents (30.2% of those performing a procedure) and was reported to be helpful in the management 90% of the time. Twenty respondents (8.8%) reported being “very” comfortable; 74 respondents (32.7%) reported being “not at all” comfortable with at least one of these procedures. The respondents who had either past instruction on the procedure (OR=33.68; p=0.000), experience performing the procedure (OR= 5.33 ; p=0.001), or trauma fellowship training (OR=4.66; p=0.003) were most likely to report a high comfort level with the procedure. Factors associated with past performance of a neurosurgical procedure were number of times deployed to a combat zone (for every unit increase, OR=2.30; p=0.002) and duration of service categorized as <1, 1-4, 5-10, 11-14 and > 15 years (for every unit increase, OR=2.12; p=0.0042). Additionally those who had performed at least one of the procedures held the opinion that general surgeons should be expected to perform such procedures (OR=7.88; p=0.006).
Conclusions: General surgeons in the deployed setting must be prepared to perform emergency neurosurgical procedures. Efforts to improve general surgeons’ overall comfort levels with the procedure should focus on retaining experienced surgeons and improving post-residency neurosurgery specific training. Additionally systems, guidelines and knowledge products including reliable 24/7 neurosurgical teleconsultation must be improved in order to facilitate the surgical management of complex combat casualties.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79018
Program Number: MSS22
Presentation Session: Full-Day Military Surgical Symposium – Trauma/Critical Care Presentations
Presentation Type: MSSPodium