2024 General Surgery/Global Health Engagement/Quality Improvement Presentations

Joseph Aryankalayil, MD1; Michael Baird, MD2; Rathnayaka Gunasingha, MD3; Margaret Shields, MS4; William Pullen, MD5; Jamie Fitch, MD6; Mark Johnson, MD7; Tamara Worlton, MD4; 1General Surgery Department, Walter Reed National Military Medical Center, Bethesda, MD; 2Orthopedic Surgery Department, Walter Reed National Military Medical Center, Bethesda, MD; 3General Surgery Department, Womack Army Medical Center, Fort Bragg, NC; 4Department of Surgery, Uniformed Services University, Bethesda, MD; 5Orthopedic Surgery Department, Medical University of South Carolina, Charleston, SC; 6General Surgery Department, Naval Medical Center Camp Lejeune, Camp Lejeune, NC; 7General Surgery Department, Portsmouth Naval Medical Center, Portsmouth, VA

Objectives: Surgical volume at Military Treatment Facilities (MTF) has been gradually decreasing for roughly the past two decades. The Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program linked surgical volume and readiness using a tool known as the KSA metric. However, the extent to which military medical missions contribute to the readiness of critical war-time specialties has not been evaluated using this metric.

Methods: A retrospective analysis was performed of the 2019 USNS Comfort mission which was 6 months (June-November 2019) in duration. Individual general surgeon KSA metrics were calculated as both a raw score and final score (diversity factor adjustment). The diversity factor adjustment includes a fractional adjustment based on the diverse scope of a surgeon’s practice, and a 7,000 KSA score limit on the inclusion of low acuity procedures. The KSA values from the mission were compared against each surgeon’s practice at their respective MTF during the remaining 6 months of the same calendar year. Orthopedic surgery does not utilize a diversity score so only raw values were reported.

Results: In 2019, the orthopedic surgeon aboard the USNS Comfort had a total KSA score of 44,006, but the 6-month USNS Comfort mission only contributed 5,364 points (12% of the annual score). The general surgery practice aboard the USNS Comfort produced lower KSA scores compared to each surgeon’s respective MTF practice (Table 1).

Conclusions: Without the adjustment for procedural diversity and low acuity procedures, the contribution of hospital ship missions to general surgery readiness appears inflated. The analysis of operative data from the 2019 USNS Comfort mission, in comparison with the surgeons' work at their respective MTFs, reveals limited benefit in the ability of these missions to bolster surgical readiness as measured by KSA. For orthopedic surgeons, the impact of the mission is only detrimental to readiness. Potential mitigation for this could be fly-in orthopedic teams, thus eliminating the ship transit times. The diplomatic mission of the hospital ship is important, however claiming it as a readiness support mission could be misleading for surgeons and planners.