Anderson Ashley B, Rivera Julio A, Flint James H, Souza Jason, Potter Benjamin K, Forsberg Jonathan A
Walter Reed National Military Medical Center, Department of Surgery, Division of Orthopaedics, Uniformed Services University, Bethesda, MD, USA.
Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, MD, USA.
Clin Orthop Relat Res. 2025 Apr 1;483(4):740-745. doi: 10.1097/CORR.0000000000003290. Epub 2024 Oct 30.
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?
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.
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.
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.
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.
美国军队中接受过专科培训的骨科肿瘤学家既要提供常规临床护理，又必须随时准备好提供战斗伤员护理。然而，肿瘤手术量较低可能会妨碍这些外科医生维持相关手术专业技能。军事卫生系统（MHS）内其他手术量较低的专科已与邻近的民用中心建立合作关系以增加手术量，但尚未研究骨科肿瘤学家建立类似合作关系的必要性。本研究的目的是描述美国军队中接受过专科培训的骨科肿瘤学家的执业模式。
问题/目的：我们提出了以下问题：（1）美国军队中接受过专科培训的骨科肿瘤学家治疗哪些诊断疾病？（2）美国军队中接受过专科培训的骨科肿瘤学家进行哪些手术？
我们使用MHS的管理和报告工具，查询了军事数据存储库，该存储库是国防卫生局内所有医疗保健受益人员（现役军人、家属和退休人员）医疗保健数据的集中存储库，涉及所有国际通用程序分类（CPT）代码以及与现役军人、接受过军队专科培训的骨科肿瘤学家的国家提供者标识符（NPI）编号相关的ICD-9和ICD-10代码。接受过专科培训的骨科肿瘤学家由军队专科负责人确定。然后，我们根据2013年至2022财年的NPI编号确定了骨科肿瘤学家进行的所有手术。我们根据相关ICD代码，将CPT代码按顶级骨科手术类别（如截肢[因肿瘤和非肿瘤原因进行]、骨折、关节成形术、肿瘤手术）进行分层。然后按治疗的最常见诊断进行列表。
13%（5996例中的796例）的诊断为肿瘤性疾病，其中45%（796例中的357例）为恶性肿瘤。44%（357例中的158例）的恶性肿瘤为原发性，56%（357例中的199例）为继发性；这意味着每位外科医生每年平均治疗2例原发性恶性肿瘤患者和2.5例继发性恶性肿瘤患者。在研究期间，9名骨科肿瘤学家进行了5996例骨科手术，即每位外科医生每年74例手术。21%（5996例中的1252例）的手术为肿瘤手术；其余手术包括897例关节成形术、502例与骨折相关的手术、275例因非肿瘤指征进行的截肢手术、204例感染手术、142例关节镜手术和2724例其他手术。
尽管军队骨科肿瘤学家拥有可直接应用于战斗伤员护理和作战准备的专业技能，但在MHS医院中，他们治疗的肿瘤诊断患者相对较少，且其中不到一半涉及恶性肿瘤。
尽管在过去十年中毕业后的手术量保持稳定，但尚不清楚为维持肌肉骨骼肿瘤专科培训后的能力或建立信心，需要有多少新的肿瘤诊断患者就诊以及相应的肿瘤手术数量。需要注意的是，目前没有军队骨科肿瘤学专科培训项目，所有现役骨科肿瘤学家都在民用机构接受培训。与高容量癌症中心建立军民合作关系，可能会使军队骨科肿瘤学家能够在民用癌症中心工作，以增加他们的肿瘤手术量，从而确保维持与作战相关的知识、技能和能力，并改善患者护理和治疗结果。
