Changes in Surgical Volume in Military Medical Treatment Facilities and Military Surgeon Clinical Combat Readiness During the COVID-19 Pandemic

Schoenfeld, Andrew J.; Ho, Hoa T.; Schoenfeld, Roman J.; Coles, Christian; Koehlmoos, Tracey Pérez

doi:10.1097/as9.0000000000000308

Annals of Surgery Open

2023

DOI: 10.1097/as9.0000000000000308

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Changes in Surgical Volume in Military Medical Treatment Facilities and Military Surgeon Clinical Combat Readiness During the COVID-19 Pandemic

Andrew J. Schoenfeld

Hoa T. Ho

Roman J. Schoenfeld³

et al.

Abstract: Mini-abstract In this retrospective study, we evaluated changes in measures of surgeon clinical combat readiness within the military health system during the COVID-19 pandemic. We found a 36% reduction in surgical knowledge and skills as compared to pre-COVID. Sizable reductions were encountered for surgery for colectomy (−50%) and aneurysm repair (−61%).

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2024

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Cited by 4 publications

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Musculoskeletal Head and Neck Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021

Yuan,

Stewart,

Colahan

et al. 2024

Military Medicine

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Background Active duty service members (ADSMs) of the U.S. Armed Forces are uniquely at risk for musculoskeletal injuries (MSKIs) of the Head/Neck region, including the eye and face, from training with head gear, donning Kevlar, operating aircraft, and maintaining sitting or standing postures for prolonged durations. The purposes of this descriptive study were to report the prevalence/incidence, health care utilization, and health care costs attributable to Head/Neck MSKIs across the Services from fiscal years (FYs) 2016 to 2021. Methods This was a retrospective, longitudinal population study, including ADSMs from the Air Force, Army, Marine Corps, and Navy. Prevalence and incidence rates for Head/Neck MSKIs, associated health care utilization, and private sector costs were obtained by querying electronic health records from military treatment facilities, private sector care (PC) claims, and theater medical data from October 1, 2015 to September 30, 2021 (FYs 16–21), using the Military Health System Data Repository. Utilization associated with Head/Neck MSKIs in both the direct care and PC settings was classified into mutually exclusive outpatient encounter categories and acute inpatient stays. PC costs related to Head/Neck MSKIs were captured for each year. Results In FY21, 109,683 ADSMs sought care for Head/Neck MSKIs, representing 7.3% of the U.S. Armed Forces. The prevalence of Head/Neck MSKIs ranged from 6.9 to 7.8% during FY16–21, with the highest annual prevalence among the Air Force (8.0–9.4%) and Army (7.9–8.8%). Within direct care across the services, Soldiers presented for the highest proportion (45.9–47.9%) of outpatient encounters for Head/Neck MSKI annually. The Air Force relied most heavily on PC for outpatient Head/Neck MSKI care, which accounted for $9,134,741 in PC costs and comprised 37.2% of all PC encounters in FY21. Conclusions This retrospective, descriptive study established prevalence/incidence, health care utilization, and PC costs for Head/Neck MSKIs across the services from FY16–21, emphasizing the burden of Head/Neck MSKIs among the U.S. Armed Forces, with PC costs amounting to $42,912,940 in FY21 alone.

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Musculoskeletal Head and Neck Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021

Yuan,

Stewart,

Colahan

et al. 2024

Military Medicine

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Evaluation of a Military Global Health Engagement Mission for Critical Wartime Surgical Specialty Readiness

Aryankalayil,

Shields,

Baird

et al. 2024

Military Medicine

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Introduction Surgical volume at Military Treatment Facilities (MTFs) has been gradually decreasing for roughly the past 2 decades. The Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program linked surgical volume and readiness using a tool known as the KSA metric. However, the extent to which military medical missions contribute to the readiness of critical wartime specialties has not been evaluated using this metric. Methods In this study, a retrospective analysis was conducted using the surgical case logs from the US Naval Ship (USNS) Comfort missions in 2018 and 2019. The comprehensive case log data were categorized by year, surgeon, procedure, and location. The analysis focused on providing detailed descriptive statistics, including percentages pertaining to the types of procedures performed during these missions. The 2018 mission was 11 weeks in duration, and supported activities in Ecuador, Peru, Colombia, and Honduras. The USNS Comfort mission in 2019 lasted 6 months (June-November 2019), and visited 12 countries in Central America, South America, and the Caribbean. Results The 2019 mission case log, spanning 6 months, was evaluated using the KSA score in order to assess readiness and compare against 6 months of MTF KSA values within the same calendar year. In 2019, the orthopedic surgeon aboard the USNS Comfort had a total KSA score of 44,006, but the 6-month USNS Comfort mission only contributed 5,364 points (12% of the annual score). The general surgery practice aboard the USNS Comfort produced lower KSA scores compared to each surgeon’s respective MTF practice (Table III). Analyzing the cases logged by general surgeons also highlights minimal surgical diversity during these missions, with more than 90% of cases being hernia repairs or laparoscopic cholecystectomies (Table I). In addition, 35% of total procedures performed in 2018 and 2019 were performed laparoscopically. Conclusions The analysis of operative data from the 2019 USNS Comfort mission, in comparison with the surgeons’ work at their respective MTFs, reveals limited benefit in the ability of hospital-ship missions to bolster surgical readiness as measured by the KSA score. However, this is not a reflection on the value of Global Health Engagement (GHE) itself but a review of the way in which it is leveraged to support surgical readiness. Military surgeons participate in GHE as part of a larger strategy to strengthen relationships with partner nations, improve military medical force interoperability, and bolster partner nation medical capacity and capabilities. The KSA score offers an excellent tool to compare readiness metrics across significantly different GHE missions, and facilitates the opportunity for future prospective studies to improve case volume, diversity, and ultimately readiness.

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Do Fellowship-educated Military Orthopaedic Oncologists Who Practice in Military Settings Treat a Sufficient Volume of Patients to Maintain Their Oncologic Expertise?

Anderson,

Rivera,

Flint

et al. 2024

Clin Orthop Relat Res

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Background Fellowship-trained orthopaedic oncologists in the US military provide routine clinical care and also must maintain readiness to provide combat casualty care. However, low oncologic procedure volume may hinder the ability of these surgeons to maintain relevant surgical expertise. Other low-volume specialties within the Military Health System (MHS) have established partnerships with neighboring civilian centers to increase procedure volume, but the need for similar partnerships for orthopaedic oncologists has not been examined. The purpose of this study was to characterize the practice patterns of US military fellowship–trained orthopaedic oncologists. Questions/purposes We asked the following questions: (1) What are the diagnoses treated by US military fellowship–trained orthopaedic oncologists? (2) What are the procedures performed by US military fellowship–trained orthopaedic oncologists? Methods We queried the Military Data Repository, a centralized repository for healthcare data for all healthcare beneficiaries (active duty, dependents, and retirees) within the Defense Health Agency using the MHS’s Management and Reporting Tool for all international common procedure taxonomy (CPT) codes and ICD-9 and ICD-10 codes associated with National Provider Identifier (NPI) numbers of active duty, military fellowship–trained orthopaedic oncologists. Fellowship-trained orthopaedic oncologists were identified by military specialty leaders. Then, we identified all procedures performed by the orthopaedic oncologist based on NPI numbers for fiscal years 2013 to 2022. We stratified the CPT codes by top orthopaedic procedure categories (such as amputation [performed for oncologic and nononcologic reasons], fracture, arthroplasty, oncologic) based on associated ICD codes. These were then tabulated by the most common diagnoses treated. Results Thirteen percent (796 of 5996) of the diagnoses were oncologic, of which 45% (357 of 796) were malignant. Forty-four percent (158 of 357) of the malignancies were primary and 56% (199 of 357) were secondary; this translates to an average of 2 patients with primary and 2.5 patients with secondary malignancies treated per surgeon per year. During the study period, nine orthopaedic oncologists performed 5996 orthopaedic procedures, or 74 procedures per surgeon per year. Twenty-one percent (1252 of 5996) of the procedures were oncologic; the remaining procedures included 897 arthroplasties, 502 fracture-related, 275 amputations for a nononcologic indication, 204 infections, 142 arthroscopic, and 2724 other procedures. Conclusion Although military orthopaedic oncologists possess expert skills that are directly translatable to combat casualty care and operational readiness, within MHS hospitals they treat relatively few patients with oncologic diagnoses, and less than one-half of those involve malignancies. Clinical Relevance Despite postgraduation procedure volume raining stable over the last decade, it is unknown how many new patient visits for oncologic diagnoses and how many corresponding tumor procedures are necessary to maintain competence or build confidence after musculoskeletal oncology fellowship training. It is important to note that there are no military orthopaedic oncology fellowships, and all active duty orthopaedic oncologists undergo training at civilian institutions. Military-civilian partnerships with high-volume cancer centers may enable military orthopaedic oncologists to work at civilian cancer centers to increase their oncologic volume to ensure sustainment of operationally relevant knowledge, skills, and abilities and improve patient care and outcomes.

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Changes in Surgical Volume in Military Medical Treatment Facilities and Military Surgeon Clinical Combat Readiness During the COVID-19 Pandemic

Cited by 4 publications

References 8 publications

Musculoskeletal Head and Neck Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021

Musculoskeletal Head and Neck Injuries in U.S. Active Duty Service Members: Prevalence/Incidence, Health Care Utilization, and Cost Analysis Spanning Fiscal Years 2016–2021

Evaluation of a Military Global Health Engagement Mission for Critical Wartime Surgical Specialty Readiness

Do Fellowship-educated Military Orthopaedic Oncologists Who Practice in Military Settings Treat a Sufficient Volume of Patients to Maintain Their Oncologic Expertise?

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