Combat thoracic surgery in Iraq and Afghanistan: 2002-2016

Area of Science:

• Military Medicine
• Surgical Training
• Trauma Surgery

Background:

• Thoracic surgery represents 2.5% of all surgical procedures.
• Skills for thoracic surgery are becoming less common among military surgeons.
• This study addresses the need to define surgical training gaps in deployed environments.

Purpose of the Study:

• To examine the thoracic surgical workload in Iraq and Afghanistan.
• To identify specific thoracic surgical procedure categories and their frequency.
• To inform the development of targeted surgical training programs for military personnel.

Main Methods:

• Retrospective analysis of the Department of Defense Trauma Registry (2002-2016).
• Inclusion of data from Role 2 (forward surgical) and Role 3 (theater) military facilities.
• Classification of 95 International Classification of Diseases-9th Rev.-Clinical Modification (ICD-9-CM) thoracic surgical procedure codes into 10 anatomical or endoscopic groups.

Main Results:

• A total of 5,301 thoracic surgical procedures were analyzed.
• The majority (87.6%) were performed at Role 3 facilities.
• Bronchoscopy (39.1%), thoracotomy (16.9%), diaphragm (15.6%), and lung (11.4%) procedures were most common. Role 3 facilities performed significantly more lung procedures, including lobectomies, than Role 2 facilities.

Conclusions:

• Thoracic surgical skills are essential for managing combat-related injuries in deployed settings.
• Current training and practice paradigms present challenges for developing and sustaining these skills.
• Addressing these training and sustainment challenges is crucial for military surgeons and humanitarian care.