2024 General Surgery/Global Health Engagement/Quality Improvement Presentations

Sharon Kim1; Pranish Katawal1; Debashree Mitra1; Robert Lee1; Joseph Aryankalayil, MD2; Tamara Worlton, MD2; 1Uniformed Services University of the Health Sciences; 2Walter Reed National Military Medical Center

Introduction: Low surgical case volumes within the Military Healthcare System (MHS) are a matter of concern for medical readiness for the DoD due the negative implications for battlefield readiness. One proposed solution to supplement current MHS surgical capacity is through direct patient care in international military surgical missions. However, very little has been studied on the efficacy of these missions and their true potential in improving surgical readiness. This study aims to survey military surgeons about their international surgical missions and their impact on readiness.

Methods: We designed an anonymous and voluntary survey for military surgeons who have engaged in different DoD international surgical missions. The survey was disseminated through the Excelsior Surgical Society,  SAGES Military Committee, as well as through triservice surgical specialty leaders. Descriptive statistical analyses, including chi-square and t-tests, were conducted on survey data using Google Sheets and SPSS.

Results: Out of a total of 131 respondents, 45 respondents engaged in international DoD surgical missions. Types of direct patient care surgical missions with the greatest number of participants included Continuing Promise (26.1%), JTF-Bravo (15.2%), Pacific Partnership (19.6%), and MEDRETE (8.7%). The majority of mission participants had general surgery training (67.4%), followed by ophthalmic surgery (8.7%), oral and maxillofacial surgery (4.3%), orthopedic surgery, (4.3%), and plastic surgery (4.3%). 54.3% of participants indicated that the mission was helpful to their surgical readiness (helpful group), while 43.5% said the mission was unhelpful or was neutral (neutral/unhelpful group). No significant difference in total case volume was found between helpful and unhelpful/neutral groups (63.0+/-82.0 vs. 62.70 +/- 88.4). Compared to the neutral/unhelpful group, the helpful group had a higher percentage of emergent cases (>36% of respondents with >25% emergent cases compared to 5% of respondents in the neutral/unhelpful group). Furthermore, a significantly greater proportion of those in the helpful group cared for critically ill patients or managed difficult cases, as marked by increased complexity or need for blood transfusion (p<0.05).

Conclusion: hese preliminary findings suggest that surgeons’ perception of surgical readiness from mission trips  may depend on involvement in complex and emergent cases, and management of critically-ill patients. DoD planning should include a nuanced evaluation of the experiences gained from certain missions rather than an overarching focus solely on case volume.