MSSP573: PRACTICE PATTERNS OF HEPATOBILIARY SURGERY WITHIN THE MILITARY
Camille R Suydam, MD; Marcos C Aranda, MD; Joy N Liang, MD; Thomas O'Hara, DO; Brad Bandera, MD; Eisenhower Army Medical Center
Objectives: The purpose of this study is to evaluate and describe the trends of hepatobiliary surgeries being done at military hospitals, and to discuss the implications these trends have on resident training and military readiness. While there is data that suggests centralization of surgical specialty services leads to improved patient outcomes, the military does not currently have a specific centralization policy in place. Implementation of such a policy could potentially impact military resident training and readiness of military surgeons. Even without a specific policy, there may still be a trend towards centralization of more complex surgeries such as hepatobiliary surgeries. This study evaluates the numbers and types of hepatobiliary procedures performed at military hospitals and the indications for these surgeries. We hypothesized that a small group of military treatment facilities perform the majority of hepatobiliary surgeries, and that there would be a downward trend in the number of hepatobiliary surgeries being performed across all military facilities.
Methods: This study is a retrospective review of de-identified data from MHS Mart (M2) from 2014 to 2020. The M2 database contains patient data from all Defense Health Agency (DHA) treatment facilities, which includes all branches of the United States Military. Variables collected include number and types of hepatobiliary procedures performed and patient demographics. The primary endpoint evaluated was the number and type of surgery for each medical facility.
Results: Twenty-nine military hospitals performed hepatobiliary surgeries from 2014 to 2020. A total of 457 hepatobiliary surgeries were performed during this time; cholecystectomies, percutaneous procedures, and endoscopic procedures were excluded in the final analysis. There was no significant change in overall case volume performed at military hospitals during this time. The most common indication for hepatobiliary surgery was a benign liver neoplasm, followed by a liver malignancy and then by trauma to the liver. The most commonly performed hepatobiliary surgery was a partial lobectomy. The military training facility with the most hepatobiliary cases was Brooke Army Medical Center, followed by Travis Air Force Base and then by Madigan Army Medical Center.
Conclusions: The number of hepatobiliary surgeries performed in military hospitals has not decreased, despite national trends towards centralization as well as trends towards centralization of other surgical subspecialties in the military. Centralization of hepatobiliary surgeries in the future may impact military training facility residency programs as well as military medical readiness.