Comparison of military and civilian surgeon outcomes with emergent trauma laparotomy in a mature military-civilian partnership

Abstract

IntroductionMedical 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.MethodsRetrospective 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.Results514 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).ConclusionTrauma-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 evidenceLevel IV, therapeutic/care management.

Predictors of Short-Term Trauma Laparotomy Outcomes in an Integrated Military–Civilian Health System: A 23-Year Retrospective Cohort Study

“…Moreover, this cohort represents a chimeric medical system where military casualties are treated at the point of injury by IDF-MC medical teams who treat them according to military clinical practice guidelines and are then transferred and operated on in modern civilian trauma centers by civilian surgeons. As the previous literature has demonstrated, there exists a dual relationship between military and civilian experience in trauma care, ultimately benefiting the patient [12,13]. Notably, we did not find that prehospital interventions, including FDP, TXA and application of needle thoracostomy or tube thoracostomy, were associated with differences in mortality among casualties undergoing a laparotomy.…”