Department of Surgery, Eisenhower Army Medical Center, Fort Gordon, USA.
Surg Endosc. 2023 Oct;37(10):7502-7510. doi: 10.1007/s00464-023-10150-6. Epub 2023 Jul 6.
The purpose of this study is to evaluate the trends of hepatobiliary surgeries performed at military hospitals and to discuss potential implications on resident training and military readiness. While there is data to suggest centralization of surgical specialty services leads to improved patient outcomes, the military does not currently have a specific centralization policy. Implementation of such a policy could potentially impact resident training and readiness of military surgeons. Even in the absence of such a policy, there may still be a trend toward centralization of more complex surgeries like hepatobiliary surgeries. The present study evaluates the numbers and types of hepatobiliary procedures performed at military hospitals.
This study is a retrospective review of de-identified data from Military Health System Mart (M2) from 2014 to 2020. The M2 database contains patient data from all Defense Health Agency treatment facilities, encompassing all branches of the United States Military. Variables collected include number and types of hepatobiliary procedures performed and patient demographics. The primary endpoint was the number and type of surgery for each medical facility. Linear regression was used to evaluate significant trends in numbers of surgeries over time.
Fifty-five military hospitals performed hepatobiliary surgeries from 2014 to 2020. A total of 1,087 hepatobiliary surgeries were performed during this time; cholecystectomies, percutaneous procedures, and endoscopic procedures were excluded. There was no significant decrease in overall case volume. The most commonly performed hepatobiliary surgery was "unlisted laparoscopic liver procedure." The military training facility with the most hepatobiliary cases was Brooke Army Medical Center.
The number of hepatobiliary surgeries performed in military hospitals has not significantly decreased over the years 2014-2020, despite a national trend toward centralization. Centralization of hepatobiliary surgeries in the future may impact residency training as well as military medical readiness.
本研究旨在评估军队医院开展肝胆外科手术的趋势，并探讨其对住院医师培训和军事准备能力的潜在影响。虽然有数据表明，外科专科服务的集中化可改善患者结局，但军队目前尚无特定的集中化政策。实施这样的政策可能会对住院医师培训和军队外科医生的准备能力产生潜在影响。即使没有这样的政策，肝胆外科等更复杂手术的集中化趋势仍然存在。本研究评估了军队医院开展的肝胆手术数量和类型。
本研究是对 2014 年至 2020 年军事医疗系统 Mart（M2）中去识别数据的回顾性分析。M2 数据库包含来自所有国防卫生局治疗机构的患者数据，涵盖了美国所有军种。收集的变量包括开展的肝胆手术数量和类型以及患者人口统计学特征。主要终点是每个医疗机构的手术数量和类型。线性回归用于评估随时间推移手术数量的显著趋势。
2014 年至 2020 年，有 55 家军队医院开展了肝胆外科手术。在此期间共进行了 1087 例肝胆手术；排除了胆囊切除术、经皮手术和内镜手术。手术总例数没有明显减少。最常见的肝胆外科手术是“未列出的腹腔镜肝手术”。开展肝胆病例数最多的军队培训基地是布洛克陆军医疗中心。
尽管全国范围内有集中化的趋势，但 2014 年至 2020 年间军队医院开展的肝胆手术数量并未显著减少。未来肝胆外科手术的集中化可能会影响住院医师培训以及军事医疗准备能力。
