Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Mar 1;9(1):e001332.
doi: 10.1136/tsaco-2023-001332. eCollection 2024.

Comparison of military and civilian surgeon outcomes with emergent trauma laparotomy in a mature military-civilian partnership

Daniel Lammers  1 , Rindi Uhlich  1 , Omar Rokayak  1 , Nathan Manley  1 , Richard D Betzold  1 , Parker Hu  1
Affiliations

Comparison of military and civilian surgeon outcomes with emergent trauma laparotomy in a mature military-civilian partnership

Daniel Lammers et al. Trauma Surg Acute Care Open. .

Abstract

Introduction: Medical readiness is of paramount concern for active-duty military providers. Low volumes of complex trauma in military treatment facilities has driven the armed forces to embed surgeons in high-volume civilian centers to maintain clinical readiness. It is unclear what impact this strategy may have on patient outcomes in these centers. We sought to compare emergent trauma laparotomy (ETL) outcomes between active-duty Air Force Special Operations Surgical Team (SOST) general surgeons and civilian faculty at an American College of Surgeons verified level 1 trauma center with a well-established military-civilian partnership.

Methods: Retrospective review of a prospectively maintained, single-center database of ETL from 2019 to 2022 was performed. ETL was defined as laparotomy from trauma bay within 90 min of patient arrival. The primary outcome was to assess for all-cause mortality differences at multiple time points.

Results: 514 ETL were performed during the study period. 22% (113 of 514) of patients were hypotensive (systolic blood pressure ≤90 mm Hg) on arrival. Six SOST surgeons performed 43 ETL compared with 471 ETL by civilian faculty. There were no differences in median ED length of stay (27 min vs 22 min; p=0.21), but operative duration was significantly longer for SOST surgeons (129 min vs 110 min; p=0.01). There were no differences in intraoperative (5% vs 2%; p=0.30), 6-hour (3% vs 5%; p=0.64), 24-hour (5% vs 5%; p=1.0), or in-hospital mortality rates (5% vs 8%; p=0.56) between SOST and civilian surgeons. SOST surgeons did not significantly impact the odds of 24-hour mortality on multivariable analysis (OR 0.78; 95% CI 0.10, 6.09).

Conclusion: Trauma-related mortality for patients undergoing ETL was not impacted by SOST surgeons when compared with their civilian counterparts. Military surgeons may benefit from the valuable clinical experience and mentorship of experienced civilian trauma surgeons at high volume trauma centers without creating a deficit in the quality of care provided.

Level of evidence: Level IV, therapeutic/care management.

Keywords: Multiple Trauma; abdominal injuries; death; hemorrhage.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
CONSORT (Consolidated Standards of Reporting Trials) flow diagram.
Figure 2
Figure 2
Box and whisker plot of average length of operation for SOST (Special Operations Surgical Team) and civilian surgeon cohorts.
Figure 3
Figure 3
Mortality rates for SOST (Special Operations Surgical Team) and CIV surgeon cohorts in patients requiring ETL (emergent trauma laparotomy).
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Yonge J, Schaetzel S, Paull J, Jensen G, Wallace J, O’Brien B, Pak G, Schreiber M, Glaser J. Optimizing combat readiness for military surgeons without trauma fellowship training: engaging the “voluntary faculty” model. J Trauma Acute Care Surg 2023;95:S31–5. 10.1097/TA.0000000000004040 - DOI - PMC - PubMed
    1. Ruggero JM, Farnand AW, Roach PB, Starr F, Tadlock MD, Bokhari F. Initial assessment of a regional military–civilian partnership on trauma surgery skills sustainment . Mil Med 2023;188:e2462–6. 10.1093/milmed/usac229 - DOI - PubMed
    1. Lee JJ, Hall AB, Carr MJ, MacDonald AG, Edson TD, Tadlock MD. Integrated military and civilian partnerships are necessary for effective trauma-related training and skills sustainment during the inter-war period. J Trauma Acute Care Surg 2022;92:e57–76. 10.1097/TA.0000000000003477 - DOI - PubMed
    1. Hall A, Qureshi I, Englert MZ, Davis E. Variability of value of trauma centers to general surgery combat casualty care skill sustainment. J Surg Educ 2021;78:1275–9. 10.1016/j.jsurg.2020.12.002 - DOI - PubMed
    1. Knudson MM, Elster EA, Bailey JA, Johannigman JA, Bailey PV, Schwab CW, Kirk GG, Woodson JA. Military–civilian partnerships in training, sustaining, recruitment, retention, and readiness: proceedings from an exploratory first-steps meeting. J Am Coll Surg 2018;227:284–92. 10.1016/j.jamcollsurg.2018.04.030 - DOI - PubMed