The United States Military Otolaryngologist's Surgical Workload in Bagram and the Effect of Subspecialty Training

This study describes the surgical workload of U.S. military otolaryngologists at a single Role 3 facility from 2016 to 2020 and evaluates whether subspecialty training influenced case distribution.

A retrospective review of operative logs from Bagram Air Base documented 1,205 procedures performed by deployed military otolaryngologists. Data included case description, procedure type, category, date, surgeon identity, and subspecialty. Data entries were organized and then analyzed using Excel pivot tables. Descriptive statistics and trend analysis were used to assess workload patterns, case distribution over time, and differences between comprehensive otolaryngologists and subspecialists.

Facial trauma comprised 52% (628/1205) of all procedures performed. Forty-eight percent (577/1205) of procedures performed treated disease or were elective reconstructive surgery, ranging year to year from 38% to 62% from 2016 to 2020. Of these 577 cases, category of case included assisting in other types of cases (34%, 195/577), general otolaryngology (33%, 189/577), facial plastics/reconstruction (18%, 102/577), otology (6%, 37/577), laryngology (6%, 33/577), rhinology (2%, 13/577), and head and neck (1%, 7/577). Half (7/14) of deployed otolaryngologists were subspecialists, including those in facial plastics, otology, rhinology, sleep, and pediatric otolaryngology. Significant differences in case mix were noted for facial plastics (P = .001), pediatric otolaryngology (P < .001), and sleep surgery (P < .001). Facial plastics and sleep surgeons performed more trauma cases (56% and 61% vs 52% for generalists), while pediatric otolaryngologists managed fewer trauma cases (38%) but more otology cases (11% vs 3%). All 3 subspecialists had fewer laryngology cases compared to generalists. Despite these differences, no specialty-specific preference in case mix was observed.

Military otolaryngologists deployed to a Role 3 setting in Bagram, Afghanistan, managed a diverse surgical workload, encompassing trauma, disease, and elective cases. While case mix differed among subspecialists, no trend toward performing subspecialty-specific procedures was observed. This study is the first to our knowledge that describes the U.S. military otolaryngologist's workload over a multi-year period at a single facility in a deployed environment. The utility of this information can, at minimum, help initial preparation and planning to forecast the needs of a military otolaryngologist in the next conflict.