在成熟的军民合作关系中，对军事外科医生和民用外科医生进行急诊创伤剖腹手术的结果比较。
Comparison of military and civilian surgeon outcomes with emergent trauma laparotomy in a mature military-civilian partnership.
作者信息
Lammers Daniel, Uhlich Rindi, Rokayak Omar, Manley Nathan, Betzold Richard D, Hu Parker
机构信息
Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA.
出版信息
Trauma Surg Acute Care Open. 2024 Mar 1;9(1):e001332. doi: 10.1136/tsaco-2023-001332. eCollection 2024.
INTRODUCTION
Medical readiness is of paramount concern for active-duty military providers. Low volumes of complex trauma in military treatment facilities has driven the armed forces to embed surgeons in high-volume civilian centers to maintain clinical readiness. It is unclear what impact this strategy may have on patient outcomes in these centers. We sought to compare emergent trauma laparotomy (ETL) outcomes between active-duty Air Force Special Operations Surgical Team (SOST) general surgeons and civilian faculty at an American College of Surgeons verified level 1 trauma center with a well-established military-civilian partnership.
METHODS
Retrospective review of a prospectively maintained, single-center database of ETL from 2019 to 2022 was performed. ETL was defined as laparotomy from trauma bay within 90 min of patient arrival. The primary outcome was to assess for all-cause mortality differences at multiple time points.
RESULTS
514 ETL were performed during the study period. 22% (113 of 514) of patients were hypotensive (systolic blood pressure ≤90 mm Hg) on arrival. Six SOST surgeons performed 43 ETL compared with 471 ETL by civilian faculty. There were no differences in median ED length of stay (27 min vs 22 min; p=0.21), but operative duration was significantly longer for SOST surgeons (129 min vs 110 min; p=0.01). There were no differences in intraoperative (5% vs 2%; p=0.30), 6-hour (3% vs 5%; p=0.64), 24-hour (5% vs 5%; p=1.0), or in-hospital mortality rates (5% vs 8%; p=0.56) between SOST and civilian surgeons. SOST surgeons did not significantly impact the odds of 24-hour mortality on multivariable analysis (OR 0.78; 95% CI 0.10, 6.09).
CONCLUSION
Trauma-related mortality for patients undergoing ETL was not impacted by SOST surgeons when compared with their civilian counterparts. Military surgeons may benefit from the valuable clinical experience and mentorship of experienced civilian trauma surgeons at high volume trauma centers without creating a deficit in the quality of care provided.
LEVEL OF EVIDENCE
Level IV, therapeutic/care management.
引言
医疗准备状态是现役军队医疗人员最为关注的问题。军事治疗机构中复杂创伤病例数量较少，促使武装部队将外科医生派驻到高容量的 civilian centers 以维持临床准备状态。尚不清楚这一策略对这些中心的患者治疗结果会产生何种影响。我们试图比较美国外科医师学会认证的一级创伤中心中，现役空军特种作战手术团队（SOST）的普通外科医生与 civilian faculty 在紧急创伤剖腹手术（ETL）方面的治疗结果，该中心有着成熟的军民合作关系。
方法
对一个前瞻性维护的、单中心的 2019 年至 2022 年 ETL 数据库进行回顾性分析。ETL 定义为患者到达后 90 分钟内在创伤室进行的剖腹手术。主要结果是评估多个时间点的全因死亡率差异。
结果
研究期间共进行了 514 例 ETL。22%（514 例中的 113 例）患者到达时为低血压（收缩压≤90 mmHg）。6 名 SOST 外科医生进行了 43 例 ETL，而 civilian faculty 进行了 471 例。急诊住院时间中位数无差异（27 分钟对 22 分钟；p = 0.21），但 SOST 外科医生的手术时间明显更长（129 分钟对 110 分钟；p = 0.01）。SOST 外科医生与 civilian 外科医生在术中（5%对 2%；p = 0.30）、6 小时（3%对 5%；p = 0.64）、24 小时（5%对 5%；p = 1.0）或院内死亡率（5%对 8%；p = 0.56）方面均无差异。在多变量分析中，SOST 外科医生对 24 小时死亡率的几率没有显著影响（OR 0.78；95%CI 0.10，6.09）。
结论
与 civilian 同行相比，接受 ETL 的患者的创伤相关死亡率并未受到 SOST 外科医生的影响。军事外科医生可能会从高容量创伤中心经验丰富的 civilian 创伤外科医生的宝贵临床经验和指导中受益，而不会导致所提供护理质量的下降。
证据水平
四级，治疗/护理管理。
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