Neurosurgical workload during US combat operations: 2002 to 2016

Turner, Caryn A.; Stockinger, Zsolt T.; Bell, Randy S.; Gurney, Jennifer M

doi:10.1097/ta.0000000000001915

Cited by 16 publications

(14 citation statements)

References 17 publications

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“…In addition, the MeS unit had the highest rates of both elective neurosurgical operations and procedures performed on Afghan civilians. [2][3][4][7][8][9][10][15][16][17] These differences from the other ISAF Role 3 field hospitals in Kabul, Bagram, Kandahar, and Lashkargah were clearly attributable to the relatively small number of troops, the less extensive combat activity and external threat situation, and regional factors with regard to religious, cultural, and ethnic conditions in northern Afghanistan.…”

Section: Discussionmentioning

confidence: 91%

Spine surgery in the International Security Assistance Force Role 3 combat support hospital in Mazar-e-Sharif, northern Afghanistan, 2007–2014

Schulz¹,

Mauer²,

Mathieu³

et al. 2018

Neurosurgical Focus

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OBJECTIVESince 2007, a continuous neurosurgery emergency service has been available in the International Security Assistance Force (ISAF) field hospital in Mazar-e-Sharif (MeS), Afghanistan. The object of this study was to assess the number and range of surgical procedures performed on the spine in the period from 2007 to 2014.METHODSThis is a retrospective analysis of the annual neurosurgical caseload statistics from July 2007 to October 2014 (92 months). The distribution of surgical urgency (emergency, delayed urgency, or elective), patient origin (ISAF, Afghan National Army, or civilian population), and underlying causes of diseases and injuries (penetrating injury, blunt injury/fracture, or degenerative disease) was analyzed. The range and pattern of diagnoses in the neurosurgical outpatient department from 2012 and 2013 were also evaluated.RESULTSA total of 341 patients underwent neurosurgical operations in the period from July 2007 to October 2014. One hundred eighty-eight (55.1%) of the 341 procedures were performed on the spine, and the majority of these surgeries were performed for degenerative diseases (127/188; 67.6%). The proportion of spinal fractures and penetrating injuries (61/188; 32.4%) increased over the study period. These spinal trauma diagnoses accounted for 80% of the cases in which patients had to undergo operations within 12 hours of presentation (n = 70 cases). Spinal surgeries were performed as an emergency in 19.8% of cases, whereas 17.3% of surgeries had delayed urgency and 62.9% were elective procedures. Of the 1026 outpatient consultations documented, 82% were related to spinal issues.CONCLUSIONSCompared to the published numbers of cases from neurosurgery units in the rest of the ISAF area, the field hospital in MeS had a considerably lower number of operations. In addition, MeS had the highest rates of both elective neurosurgical operations and Afghan civilian patients. In comparison with the field hospital in MeS, none of the other ISAF field hospitals showed such a strong concentration of degenerative spinal conditions in their surgical spectrum. Nevertheless, the changing pattern of spine-related diagnoses and surgical therapies in the current conflict represents a challenge for future training and material planning in comparable missions.

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Section: Discussionmentioning

confidence: 91%

Spine surgery in the International Security Assistance Force Role 3 combat support hospital in Mazar-e-Sharif, northern Afghanistan, 2007–2014

Schulz¹,

Mauer²,

Mathieu³

et al. 2018

Neurosurgical Focus

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“…Traumatic brain injury (TBI) is the most common cause of death on the modern battlefield for coalition military forces 1–4. Coalition medical treatment facilities (MTF) in Iraq and Afghanistan are classified by the North Atlantic Treaty Organisation (NATO) into Roles (or echelons) 5 6.…”

Section: Introductionmentioning

confidence: 99%

“…The US and UK adopted different approaches to the specialty mix of surgeons responsible for treating patients with HI 14–21. The US deployed neurosurgeons to specific Role 3 MTF 4 15. At the other Role 3 MTFs and all Role 2 MTFs casualties, TBIs were either treated by non-neurosurgeons or were stabilised and tactically evacuated (TACEVAC) to a Role 3 MTF where a neurosurgeon was present.…”

Section: Introductionmentioning

confidence: 99%

“…Multiple papers from the US and UK have described the management and outcomes of recent military patients3–6 15 16 19 24–27; however, direct comparison of outcomes is challenging, as differences in methodology and terminology have been used. Our aim was to compare the incidence, injury types and treatment in US and UK-led military MTF to ascertain if differences in surgical care pathways for patients with HI affected outcomes.…”

Section: Introductionmentioning

confidence: 99%

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Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts

Breeze

Bowley

Harrisson

et al. 2020

J Neurol Neurosurg Psychiatry

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IntroductionTraumatic brain injury (TBI) is the most common cause of death on the modern battlefield. In recent conflicts in Iraq and Afghanistan, the US typically deployed neurosurgeons to medical treatment facilities (MTFs), while the UK did not. Our aim was to compare the incidence, TBI and treatment in US and UK-led military MTF to ascertain if differences in deployed trauma systems affected outcomes.MethodsThe US and UK Combat Trauma Registries were scrutinised for patients with HI at deployed MTFs between March 2003 and October 2011. Registry datasets were adapted to stratify TBI using the Mayo Classification System for Traumatic Brain Injury Severity. An adjusted multiple logistic regression model was performed using fatality as the binomial dependent variable and treatment in a US-MTF or UK-MTF, surgical decompression, US military casualty and surgery performed by a neurosurgeon as independent variables.Results15 031 patients arrived alive at military MTF after TBI. Presence of a neurosurgeon was associated with increased odds of survival in casualties with moderate or severe TBI (p<0.0001, OR 2.71, 95% CI 2.34 to 4.73). High injury severity (Injury Severity Scores 25–75) was significantly associated with a lower survival (OR 4×104, 95% CI 1.61×104 to 110.6×104, p<0.001); however, having a neurosurgeon present still remained significantly positively associated with survival (OR 3.25, 95% CI 2.71 to 3.91, p<0.001).ConclusionsPresence of neurosurgeons increased the likelihood of survival after TBI. We therefore recommend that the UK should deploy neurosurgeons to forward military MTF whenever possible in line with their US counterparts.

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“…4 The efficiency and expertise of military neurosurgery reaches a pinnacle during episodes of conflict, as demonstrated by more than 7500 neurosurgical procedures being performed during US conflicts from 2002 to 2016. 26 Today these numbers have exponentially decreased, but during these times of peace and relatively low conflict, maintaining the types of neurosurgical proficiency required in battlefield environments (Fig. 1) is challenging for active-duty neurosurgeons.…”

mentioning

confidence: 99%

Direct enhancement of readiness for wartime critical specialties by civilian-military partnerships for neurosurgical care: residency training and beyond

Shin

Hooten

Sindelar

et al. 2018

Neurosurgical Focus

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Military neurosurgery has played an integral role in the development and innovation of neurosurgery and neurocritical care in treating battlefield injuries. It is of paramount importance to continue to train and prepare the next generation of military neurosurgeons. For the Army, this is currently primarily achieved through the military neurosurgery residency at the National Capital Consortium and through full-time out-service positions at the Veterans Affairs–Department of Defense partnerships with the University of Florida, the University of Texas–San Antonio, and Baylor University. The authors describe the application process for military neurosurgery residency and highlight the training imparted to residents in a busy academic and level I trauma center at the University of Florida, with a focus on how case variety and volume at this particular civilian-partnered institution produces neurosurgeons who are prepared for the complexities of the battlefield. Further emphasis is also placed on collaboration for research as well as continuing education to maintain the skills of nondeployed neurosurgeons. With ongoing uncertainty regarding future conflict, it is critical to preserve and expand these civilian-military partnerships to maintain a standard level of readiness in order to face the unknown with the confidence befitting a military neurosurgeon.

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Neurosurgical workload during US combat operations: 2002 to 2016

Abstract: Epidemiologic study, level III; Care Management, level IV.

Cited by 16 publications

References 17 publications

Spine surgery in the International Security Assistance Force Role 3 combat support hospital in Mazar-e-Sharif, northern Afghanistan, 2007–2014

Spine surgery in the International Security Assistance Force Role 3 combat support hospital in Mazar-e-Sharif, northern Afghanistan, 2007–2014

Survival after traumatic brain injury improves with deployment of neurosurgeons: a comparison of US and UK military treatment facilities during the Iraq and Afghanistan conflicts

Direct enhancement of readiness for wartime critical specialties by civilian-military partnerships for neurosurgical care: residency training and beyond

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