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Military Deployment's Impact on the Surgeon's Practice.

BACKGROUND
As the United States withdraws from overseas conflicts, general surgeons remain deployed in support of global operations. Surgeons and surgical teams are foundational to combat casualty care; however, currently there are few casualty producing events. Low surgical volume and acuity can have detrimental effects on surgical readiness for those frequently deployed. The surgical team cycle of deployment involves pre deployment training, draw-down of clinical practice, deployment, post deployment reintegration and rebuilding of a patient panel. This study aims to assess these effects on typical general surgeon practices. Quantifying the overall impact of deployment may help refine and implement measures to mitigate the effects on skill retention and patient care.


METHODS
Surgeon case logs of eligible surgeons deploying between January 1, 2017 and January 1, 2020 were included from participating military treatment facilities (MTF). Eligible surgeons were surgeons whose case logs were primarily at a single MTF(s) 26 weeks prior and after deployment and whose deployment duration, location, and number of deployed cases were obtainable.


RESULTS
Starting 26 weeks prior to deployment, analyzing in one-week intervals towards deployment time, case count decreased by 4.8% (p < .0001). With each one-week interval post deployment up to the 26-week mark, case count increased by 6% (p < .0001). Cases volumes most prominently drop 3 weeks prior to deployment and do not reach normal levels until approximately 7 weeks post deployment. Case volumes were similar across service branches.


CONCLUSIONS
There is a significant decrease in the number of cases performed before deployment and increase after return regardless of military branch. The peri-deployment surgical volume decline should be understood and mitigated appropriately; pre-deployment training, surgical skill retention and measures to safely reintegrate surgeons back into their practice should be further developed and implemented.


LEVEL OF EVIDENCE
Level III Economic/Decision.