Vascular Surgery During U.S. Combat Operations from 2002–2016: Analysis of Vascular Procedures Performed to Inform Military Training

Background Vascular surgery constitutes approximately 6.5% of surgical procedures performed for combat injuries, yet general surgeons are increasingly unfamiliar with vascular surgery. This study examines the frequency and type of vascular surgical procedures performed during recent U.S. Military operations from 2002–2016. Methods A retrospective analysis of the Department of Defense Trauma Registry (DoDTR) was performed for all Role 2 and Role 3 MTFs, from January 2002 to May 2016. A total of 106 ICD-9-CM procedure codes were categorized as vascular and were included in the present analysis. Procedure codes were separated by anatomic location and procedure type. Ligation as part of an amputation was excluded. Grafts were further subdivided by type: Synthetic, Autologous, and Unknown. Procedure grouping and categorization were determined by subject matter experts. Data analysis used Stata Version 14 (College Station, Texas). Results A total of 25,816 vascular surgical procedures were identified at Role 2 and Role 3 MTFs. R3 MTFs reported more than 4 times the number of procedures compared to R2 MTFs. The most common anatomic locations documented were extremity (64.96%), and NOS (28.1%). The most common procedures overall were amputation (33.36%), and fasciotomy (18.83%). The most common graft type was autologous (68.87%) and the least common was synthetic (5.69%). Conclusions While amputation, fasciotomy and ligation were the most common vascular procedures performed for combat trauma, the need for definitive repair including grafting is common at both Role 2 and Role 3 MTFs. Vascular surgery therefore remains a necessary skill set for the deployed U.S. Military surgeon; military general surgeons need to train and sustain their vascular skills, including proficiency at amputation and fasciotomy. Level of Evidence Level III, Epidemiologic study Correspondence: Caryn A. 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. 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: 3rd Annual Meeting of the San Antonio Military Health System and Universities Research Forum, June 16, 2017 in San Antonio, Texas. © 2018 Lippincott Williams & Wilkins, Inc.

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