Treatment of Gallbladder Disease During Operations Iraqi Freedom and Enduring Freedom

INTRODUCTION: We examined the outcome after treatment for gallbladder disease in deployed military service members and the impact of instituting a clinical pathway to expedite return to duty (RTD). METHODS AND PROCEDURES: A retrospective chart review of 97 medically evacuated patients with gallbladder disease was analyzed. These patients were evacuated from the field to Landstuhl Regional Medical Center (LRMC), Germany, between March 2003 and November 2004. In October 2003, a clinical pathway was established to aid in returning these deployed patients back to their combat units. These service members were compared to 90 local patients who underwent the same surgery during the study period. RESULTS: Prior to the implementation of the clinical pathway, 29 patients were treated at LRMC. Of those, 15 (52%) returned to their deployed units. After the clinical pathway was established, 57 of 68 patients (84%) returned to duty. The Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) service members had delayed presentations for definitive treatment. When compared to the local patient group, OIF/OEF surgical cases were more often male (78% vs. 32%), younger (31 vs. 35), associated with longer operative times (89 min vs. 52 min), higher conversion rates to open (7.2% vs. 2.2%) and higher major complication rate (6.2% vs. 0%). Gender, operative times, conversion rate and complication rate were significantly different between the two groups. No significant differences were noted in age or final pathologic diagnosis. CONCLUSION: Gallbladder surgery can be performed in a delayed manner in the deployed service member although with a significantly higher morbidity as compared to the local population. These findings suggest that changes in the immediate treatment and transportation of these service members should occur at the theater level. The use of a clinical pathway facilitates the rapid RTD for soldiers diagnosed with gallbladder disease.

Session: Podium Presentation

Program Number: S116