Abdominal Trauma Surgery During Recent U.S. Combat Operations from 2002-2016

Background Abdominal surgery constitutes approximately 13% of surgical procedures performed for combat injuries. This study examines the frequencies and type of abdominal surgical procedures performed during recent U.S. Military operations. Methods A retrospective analysis of the Department of Defense Trauma Registry (DoDTR) was performed for all Role 2 (R2) and Role 3 (R3) medical treatment facilities (MTFs), from January 2002 to May 2016. The 273 ICD-9-CM procedure codes that were identified as abdominal surgical procedures were stratified into 24 groups based on anatomic and functional classifications and then grouped by whether or not they were laparoscopic. Procedure grouping and categorization were determined, and adjudicated if necessary, by subject matter experts. Data analysis used Stata Version 14 (College Station, Texas). Results A total of 26,548 abdominal surgical procedures were identified at R2 and R3 MTFs. The majority of abdominal surgical procedures were reported at R3 facilities. The largest procedure group at both R2 and R3 MTFs were procedures involving the bowel. There were 18 laparoscopic procedures reported (R2:4 R3:14). Laparotomy Not Otherwise Specified was the second largest procedure group at both R2 (1,060, 24.55%) and R3 (4,935, 22.2%) MTFs. Abdominal caseload was variable over the 15 year study period. Conclusions Surgical skills such as open laparotomy and procedures involving the bowel are crucial in war surgery. The abundance of laparotomy NOS may reflect inadequate documentation, or the plethora of 2nd and 3rd look operations and washouts performed for complex abdominal injuries. Traditional elective general surgical cases (gallbladder, hernia) were relatively infrequent. Laparoscopy was almost nonexistent. Open abdominal surgical skills therefore remain a necessity for the deployed U.S. Military General Surgeons; this is at odds with the shifting paradigm from open to laparoscopic skills in stateside civilian and military hospitals. Level of Evidence Level III, Epidemiologic study Correspondence: Caryn Turner, MPH, Joint Trauma System, San Antonio Military Medical Center, 3698 Chambers Pass, Bldg. 3611, Ft. Sam Houston, Texas 78234-7767, Phone: 806-549-7821, Fax: 210-539-8215. Email: Caryn.A.Turner.ctr@mail.mil; Caryn.A.Turner@gmail.com Conflict of Interest: The authors declare no conflicts of interest. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army, Department of the Navy or the Department of Defense. Support and funding for this study was provided in part by an apportionment of one author (C.A.T) to the Research Participation Program for the U.S. Army Institute of Surgical Research, Joint Trauma System, administered by the Oak Ridge Institute for Science and Education through an agreement between the Department of Energy and the Department of Defense. Presentations: Poster: 2017 Military Health System Research Symposium: August 27-30, 2017 in Kissimmee, Florida. © 2018 Lippincott Williams & Wilkins, Inc.

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