Changes in surgical workload at the JF Med Gp Role 3 Hospital, Camp Bastion, Afghanistan, November 2008-November 2010

Abstract

Introduction: The operative workload at the surgical facility in Camp Bastion, Afghanistan, has previously been reported for the two-year period 1 May 2006 to 1 May 2008. There have since been considerable changes not only in the casualty rates, but also in the injury patterns encountered. Severe wounds from improvised explosive devices (IEDs) have become the signature injury of the insurgency. We present recent data for the surgical activity at the Joint Forces Medical Group Role 3 Hospital, Camp Bastion, for the two-year period 1 November 2008 to 1 November 2010.

Patients and methods: A retrospective analysis of the operating theatre logbooks was undertaken for the period 1 November, 2008 to 1 November, 2010.

Results: During the study period a total of 4276 cases required 5737 surgical procedures. Compared with the previously reported series from May 2006 to 2008, this represents a 2.6-fold increase in the surgical workload of the hospital. There has been a 5.7-fold increase in the number of amputations (483 during this study period, 8.4% all operative procedures), and for the lower limbs these have become increasingly proximal (48% all amputations were above-knee lower limb amputations). During the study period there were also significant increases in the frequency of perineal injuries as well as the numbers of cases involving 5 or more surgeons.

Discussion: The surgical workload at the Role 3 Hospital, Camp Bastion, Afghanistan is increasing. This is a result not only of increasing casualty numbers but also of increasingly severe injury patterns. With the growing use of powerful IEDs, traumatic lower limb amputations in particular are becoming more common, and are increasingly associated with significant pelvic and perineal injury. These complex injury patterns necessitate a multi-surgeon approach, and it is important these trends are noted for future planning of medical support to military operations in Afghanistan.