NeuroSurgical Workload During U.S. Combat Operations: 2002-2016

Background Approximately 4.5% of surgical procedures performed at Role 2 (forward surgical) and Role 3 (theater) medical treatment facilities can be classified as neurosurgical. These procedures are foreign to the routine daily practice of the military general surgeon. The purpose of this study is to examine the neurosurgical workload in Iraq and Afghanistan in order to inform the future predeployment neurosurgical training needs of non-neurosurgical providers. Methods Retrospective analysis of the Department of Defense Trauma Registry (DoDTR) for all Role 2 and Role 3 medical facilities, from January 2002 to May 2016. The 103 neurosurgical ICD-9-CM procedure codes identified were grouped by anatomic location. Select groups were further subdivided. Data analysis used Stata Version 14 (College Station, Texas). Results A total of 7,509 neurosurgical procedures were identified. The majority (7,244, 96.5%) occurred at Role 3 theatre hospitals. Cranial procedures were the most common at both Role 2 (120, 45.3%) and Role 3 (4,483, 61.9%), with craniotomy/craniectomy the most frequent procedure. Spine procedures were performed almost exclusively at Role 3, with 61.1% being fusions/stabilizations, and 26.9% being spinal decompression alone. Neurosurgical caseload was variable over the 15 year study period, dropping to almost zero in 2016. Conclusions Neurosurgical procedures were performed primarily at larger Role 3 theatre hospitals where neurosurgeons were assigned if present in theater; however, over 100 cranial procedures were performed at forward Role 2s where neurosurgeons were not deployed. Considering that neurosurgeons are not everywhere available within the war zone, deploying general surgeons should have familiarity with trauma neurosurgery. 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: 888-422-2007, Ext. 313. 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. Presentations: Quick Shot: 31st Annual Meeting of the Eastern Association for the Surgery of Trauma, January 9-13, 2018 in Lake Buena Vista, Florida. © 2018 Lippincott Williams & Wilkins, Inc.

from Emergency Medicine via xlomafota13 on Inoreader https://ift.tt/2IZ54QL