Sykes Alicia G, Brill Jason B, Wallace James D, Lee Clara, Lewis Paul R, Henry Marion C, Christman Matthew S, Casey Kevin M, Bickler Stephen W, Ignacio Romeo C
Department of Surgery, Naval Medical Center San Diego, San Diego, CA 92134, USA.
Division of Pediatric Surgery, The University of Chicago Medicine, Comer Children's Hospital, Chicago, IL 60637, USA.
Mil Med. 2023 Jul 22;188(7-8). doi: 10.1093/milmed/usab500. Epub 2021 Dec 15.
Since 2006, the U.S. Navy has conducted six Pacific Partnership (PP) missions throughout Southeast Asia on board the U.S. Naval Ship Mercy (T-AH 19). This study describes trends in overall and surgical specialty operative volumes to better understand the burden of surgical disease treated during these humanitarian and civic assistance (HCA) operations. This information can assist medical planners and surgical leaders involved in future humanitarian missions.
Following approval from the Naval Medical Center San Diego Institutional Review Board, a retrospective review of surgical case data was performed for the six PP missions from 2006 to 2018. Data collected included patient demographics, Current Procedural Terminology codes, and surgical specialty. The primary outcome was surgical case volume per specialty. Secondary outcomes included surgical staffing per mission and overall trends in operative volume.
A total of 3,826 operative procedures were performed during the study period. Mission years in which case volume for both general surgery and ophthalmology were below their respective medians were associated with the least total surgical services to host nations (HNs). The number of active duty Navy surgeons varied with each mission; however, the staffing for a PP mission generally included at least two general surgeons, one ophthalmologist, one plastic surgeon, one pediatric surgeon, one orthopedic surgeon, one otolaryngologist, one oral surgeon, one urologist, and one obstetrician-gynecologist. Case volume per surgeon was highest in 2006 (50 cases per surgeon) and decreased after 2006, reaching an all-time low during the 2018 PP mission (10 cases per surgeon). Pediatric surgery and plastic surgery had the highest average case volumes per surgeon at 58 and 46 cases per surgeon, respectively, while oromaxillofacial surgery and neurosurgery had the lowest average case volumes per surgeon at 9 and 14 cases per surgeon, respectively.
Operative volume on military HCA missions is greatly influenced by the priorities of the HN, the mission focus, the number of individuals from the HN that present for screening, and the availability of personnel and resources available on the hospital ship. Future mission planning should optimize general surgery and ophthalmology staffing and essential equipment, as total mission case volumes were highly dependent upon the productivity of these two specialties. Careful determination of the surgical needs of HNs should serve as a guide for the selection of subspecialists to maximize effectiveness in future military HCA missions.
自2006年以来，美国海军已在美国海军“仁慈号”医院船（T-AH 19）上在东南亚执行了6次“太平洋伙伴关系”（PP）任务。本研究描述了总体手术量和各外科专科手术量的趋势，以更好地了解在这些人道主义和民事援助（HCA）行动中所治疗的外科疾病负担。这些信息可帮助参与未来人道主义任务的医疗规划人员和外科负责人。
经圣地亚哥海军医疗中心机构审查委员会批准，对2006年至2018年的6次PP任务的手术病例数据进行了回顾性审查。收集的数据包括患者人口统计学信息、现行手术操作术语编码和外科专科。主要结果是各专科的手术病例数。次要结果包括每次任务的手术人员配备和手术量的总体趋势。
在研究期间共进行了3826例手术。普通外科和眼科的病例数均低于各自中位数的任务年份，与向东道国（HN）提供的外科服务总量最少相关。现役海军外科医生的人数因每次任务而异；然而，一次PP任务的人员配备通常包括至少两名普通外科医生、一名眼科医生、一名整形外科医生、一名小儿外科医生、一名骨科医生、一名耳鼻喉科医生、一名口腔外科医生、一名泌尿科医生和一名妇产科医生。每位外科医生的病例数在2006年最高（每位外科医生50例），2006年后下降，在2018年PP任务期间降至历史最低水平（每位外科医生10例）。小儿外科和整形外科每位外科医生的平均病例数最高，分别为每位外科医生58例和46例，而口腔颌面外科和神经外科每位外科医生的平均病例数最低，分别为每位外科医生9例和14例。
军事HCA任务中的手术量受东道国的优先事项、任务重点、前来筛查的东道国人员数量以及医院船上可用的人员和资源的可用性的极大影响。未来的任务规划应优化普通外科和眼科的人员配备及基本设备，因为任务总病例数高度依赖于这两个专科的工作效率。仔细确定东道国的外科需求应作为选择亚专科医生的指南，以在未来军事HCA任务中最大限度地提高效率。
