James D Wallace, MD, Jason B Brill, MD, Paul R Lewis, DO, Matthew S Christman, MD, Eamon B O’Reilly, MD, Marion C Henry, MD, Romeo C Ignacio, MD. Naval Medical Center San Diego (NMCSD)
Objective: Surgical humanitarian aid (HA) has recently received greater attention as research has demonstrated the value of global surgery in low middle income countries (LMIC). Pacific Partnership is an annual humanitarian civic assistance mission conducted by the US Navy that deploys either an amphibious warship or the hospital ship USNS Mercy (T-AH 19) to Southeast Asia. The USNS Mercy’s crew is largely comprised of staff from Naval Medical Center San Diego (NMCSD). Hypothesizing that the hospital’s surgical services are significantly strained when the USNS Mercy is deployed, we compared hospital surgical case volume when this ship is deployed to when it is in port.
Methods: Using existing ship and hospital system de-identified quality improvement data, we performed a retrospective cross-sectional study on all cases from 2010-2015. Demographic and case-specific variables were analyzed in order to compare surgical case volume at NMCSD during the months when the USNS Mercy was deployed to when it was in port. The primary outcome was number of surgical cases performed at NMCSD. Secondary outcomes included case complexity and patient disengagement costs.
Results: The average number of hospital cases was not dependent on HA deployments (3324 deployed vs 3673 in port, p = 0.158). A similar number of cases were conducted in all study years; independent of surgical service, beneficiary category, or patient age, except for 2015. During the 2015 Mercy deployment, significantly fewer pediatric procedures were performed compared other study years (147 vs average 240). In 2015 the hospital’s only pediatric urologist and one of two pediatric surgeons were both deployed. As a result, fewer pediatric urology cases were performed in 2015 than any other study year (9 vs average 103). There were 197 pediatric urology disengagements during 2015 as compared to 32 disengagements during the 2014 mission months. These disengagements led to $486,035 paid outside of the military health system for pediatric urology purchased care during this deployment period.
Conclusions: NMCSD is able to maintain garrison surgical services while staffing HA deployments. Surgeons are able to provide both intra- and interdepartmental cross coverage. Future mission planning should focus on deployment of the selected surgeon specialist not only for the proposed mission but also for preservation of services at medical treatment facilities.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78312
Program Number: MSSP05
Presentation Session: Military Poster (Non CME)
Presentation Type: MSSPoster
