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Elective pediatric surgical care in a forward deployed setting: What is feasible vs. what is reasonable
Lucas P Neff1, Jeremy W Cannon2, Kathryn M Charnock3
1Department of Surgery, David Grant Medical Center, 101 Bodin Circle, Travis Air Force Base, California 94535; Department of Surgery, UC Davis Medical Center, 2315 Stockton Blvd. Sacramento, California 95817; Department of Surgery, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, Maryland 20814.
Insights
Elective pediatric surgery during combat operations is feasible, but careful patient selection is crucial due to resource limitations. Further guidance is needed for humanitarian surgical missions in deployed settings.
Area of Science:
- Pediatric Surgery
- Combat Medicine
- Humanitarian Aid
Background:
- Elective humanitarian surgery for Afghan children was part of Operation Enduring Freedom (OEF).
- Limited outcome data exists for pediatric elective surgery in combat zones, hindering treatment decisions.
Purpose of the Study:
- To analyze the scope and outcomes of elective pediatric surgical procedures during combat operations.
- To provide data guiding future surgical care in deployed environments.
Main Methods:
- Retrospective review of elective pediatric surgeries (≤16 years) from May 2012 to April 2014.
- Procedures categorized by surgical specialty and classified as single-stage or multi-stage.
- Primary endpoint: post-operative complications requiring re-operation; Secondary endpoint: follow-up completion.
Main Results:
- 311 procedures performed on 239 pediatric patients across various surgical specialties.
- 15 patients (6.3%) experienced complications requiring 32 additional procedures.
- All patients survived to discharge; 87% attended outpatient follow-up.
Conclusions:
- Elective pediatric surgery is feasible in forward-deployed settings.
- Resource limitations necessitate careful patient selection, especially for procedures with prolonged recovery.
- Formal guidelines are needed for selecting patients for humanitarian surgery in austere environments.
Objective:
To describe the scope and outcomes of elective pediatric surgical procedures performed during combat operations.
Background:
The care of patients in Operation Enduring Freedom (OEF) includes elective humanitarian surgery on Afghan children. Unlike military reports of pediatric trauma care, there is little outcome data on elective pediatric surgical care during combat operations to guide treatment decisions.
Methods:
All elective surgical procedures performed on patients≤16years of age from May 2012 through April 2014 were reviewed. Procedures were grouped by surgical specialty and were further classified as single-stage (SINGLE) or multi-stage (MULTI). The primary endpoint was post-operative complications requiring further surgery, and the secondary endpoint was post-operative follow up.
Results:
A total of 311 elective pediatric surgical procedures were performed on 239 patients. Surgical specialties included general surgery, orthopedics, otolaryngology, ophthalmology, neurosurgery and urology. 178 (57%) were SINGLE while 133 (43%) were MULTI. Fifteen patients required 32 procedures for post-operative complications. Approximately half of all procedures were performed as outpatient surgery. Median length of stay for inpatient was 2.2days, and all patients survived to discharge. The majority of patients returned for outpatient follow-up (207, 87%), and 4 patients (1.7%) died after discharge.
Conclusions:
Elective pediatric surgical care in a forward deployed setting is feasible; however, limitations in resources for perioperative care and rehabilitation mandate prudent patient selection particularly with respect to procedures that require prolonged post-operative care. Formal guidance on the process of patient selection for elective humanitarian surgery in these settings is needed.
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