Effect of Deployed Cardiothoracic Surgeons on Clinical Outcomes in U.S. Service Members with Thoracic Trauma in...

Conflicts related to Operation Iraqi Freedom (OIF) led to nearly 32,000 wounded U.S. service members, with thoracic injuries seen in 8.6% of casualties. Our aim was to better understand the effects of deployed cardiothoracic surgeons.

A retrospective analysis of DoD Trauma Registry data was performed. Inclusion criteria included U.S. service members with thoracic trauma that sought care at the role 3 hospital at Balad and received a cardiothoracic procedure from 2004 to 2011 during OIF. Deployment timelines were established to determine when a U.S. Air Force cardiothoracic surgeon was present at Balad. Patients that met inclusion criteria were divided 2 two cohorts based on the presence of a cardiothoracic surgeon. Clinical outcomes were assessed and compared between the 2 cohorts.

One hundred and nine patients met inclusion criteria; 93.6% (n = 102) of these patients were treated at Balad when a cardiothoracic surgeon was present and 6.4% (n = 7) when a cardiothoracic surgeon was not present. Ninety-eight percent of all patients from both cohorts were male and the most common mechanism of injury was penetrating (58.7%, n = 64). Average Injury Severity Score of patients when a cardiothoracic surgeon was present was 27.6 and when one was not was 29.4 (P-value .73). The most common injury observed between both cohorts was a pneumothorax and the most common thoracic procedure performed at Balad was bronchoscopy followed by chest tube placement. Mortality rate of 9.8% was observed in the cohort where a cardiothoracic surgeon was present and 14.3% in the cohort where a cardiothoracic surgeon was not present (P-value .70).

A U.S. Air Force cardiothoracic surgeon was present at Balad for a large percentage of the time during OIF. The severity/distribution of patient injury and clinical outcomes appeared similar when a cardiothoracic surgeon was present/not present.