Abstract
Background: We examined the outcome after treatment for gallbladder disease in deployed military service members and the impact of instituting a clinical pathway to expedite return to duty (RTD). Methods: A retrospective chart review of 97 medically evacuated patients with gallbladder disease was carried out. These patients were evacuated from the field to Landstuhl Regional Medical Center (LRMC), Germany, between March 2003 and November 2004. In October 2003, a clinical pathway was established to facilitate returning these deployed patients back to their combat units. These service members were compared with 90 local patients who underwent the same surgery during the study period. Results: Twenty-nine patients were treated before the implementation of the clinical pathway. Of those, five had complications, five were converted to open, and 52% returned to their deployed units. After the clinical pathway was established, there were no complications (p = 0.023), two were converted to open (p = 0.002), and 84% returned to duty (p = 0.002). The Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) service members had delayed presentations for definitive treatment. When compared with the local patient group, OIF/OEF surgical cases were more often male (78 vs. 32%, p <0.001), younger (average 31 vs. 35 years, p <0.001), and associated with longer operative times (89 vs. 52 min, p <0.001), and had higher conversion rate to open (7.2 vs. 2.2%, p = 0.17) and higher major complication rate (5.1 vs. 0%, p = 0.06). Time to operation and final pathologic diagnosis were significantly different between the two groups. Conclusions: Gallbladder surgery can be performed in a delayed manner in the deployed service member, although with a significantly higher morbidity as compared with the local population. We suggest that changes in the immediate treatment and transportation of these service members should occur at the theater level. The use of a clinical pathway facilitates the rapid RTD of soldiers diagnosed with gallbladder disease.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 2702-2707 |
| Number of pages | 6 |
| Journal | Surgical Endoscopy and Other Interventional Techniques |
| Volume | 23 |
| Issue number | 12 |
| DOIs | |
| State | Published - Dec 2009 |
| Externally published | Yes |
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Keywords
- Cholecystectomy
- Clinical pathway
- Gallbladder disease
- Military medicine
- Operation Enduring Freedom
- Operation Iraqi Freedom
- Postoperative convalescence
- Return to duty
ASJC Scopus subject areas
- Surgery
Cite this
Treatment of gallbladder disease during operations Iraqi Freedom and Enduring Freedom. / Edwards, Chad R.; Dolan, James; Fang, Raymond; Standaert, Richard E.
In: Surgical Endoscopy and Other Interventional Techniques, Vol. 23, No. 12, 12.2009, p. 2702-2707.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Treatment of gallbladder disease during operations Iraqi Freedom and Enduring Freedom
AU - Edwards, Chad R.
AU - Dolan, James
AU - Fang, Raymond
AU - Standaert, Richard E.
PY - 2009/12
Y1 - 2009/12
N2 - Background: We examined the outcome after treatment for gallbladder disease in deployed military service members and the impact of instituting a clinical pathway to expedite return to duty (RTD). Methods: A retrospective chart review of 97 medically evacuated patients with gallbladder disease was carried out. These patients were evacuated from the field to Landstuhl Regional Medical Center (LRMC), Germany, between March 2003 and November 2004. In October 2003, a clinical pathway was established to facilitate returning these deployed patients back to their combat units. These service members were compared with 90 local patients who underwent the same surgery during the study period. Results: Twenty-nine patients were treated before the implementation of the clinical pathway. Of those, five had complications, five were converted to open, and 52% returned to their deployed units. After the clinical pathway was established, there were no complications (p = 0.023), two were converted to open (p = 0.002), and 84% returned to duty (p = 0.002). The Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) service members had delayed presentations for definitive treatment. When compared with the local patient group, OIF/OEF surgical cases were more often male (78 vs. 32%, p <0.001), younger (average 31 vs. 35 years, p <0.001), and associated with longer operative times (89 vs. 52 min, p <0.001), and had higher conversion rate to open (7.2 vs. 2.2%, p = 0.17) and higher major complication rate (5.1 vs. 0%, p = 0.06). Time to operation and final pathologic diagnosis were significantly different between the two groups. Conclusions: Gallbladder surgery can be performed in a delayed manner in the deployed service member, although with a significantly higher morbidity as compared with the local population. We suggest that changes in the immediate treatment and transportation of these service members should occur at the theater level. The use of a clinical pathway facilitates the rapid RTD of soldiers diagnosed with gallbladder disease.
AB - Background: We examined the outcome after treatment for gallbladder disease in deployed military service members and the impact of instituting a clinical pathway to expedite return to duty (RTD). Methods: A retrospective chart review of 97 medically evacuated patients with gallbladder disease was carried out. These patients were evacuated from the field to Landstuhl Regional Medical Center (LRMC), Germany, between March 2003 and November 2004. In October 2003, a clinical pathway was established to facilitate returning these deployed patients back to their combat units. These service members were compared with 90 local patients who underwent the same surgery during the study period. Results: Twenty-nine patients were treated before the implementation of the clinical pathway. Of those, five had complications, five were converted to open, and 52% returned to their deployed units. After the clinical pathway was established, there were no complications (p = 0.023), two were converted to open (p = 0.002), and 84% returned to duty (p = 0.002). The Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) service members had delayed presentations for definitive treatment. When compared with the local patient group, OIF/OEF surgical cases were more often male (78 vs. 32%, p <0.001), younger (average 31 vs. 35 years, p <0.001), and associated with longer operative times (89 vs. 52 min, p <0.001), and had higher conversion rate to open (7.2 vs. 2.2%, p = 0.17) and higher major complication rate (5.1 vs. 0%, p = 0.06). Time to operation and final pathologic diagnosis were significantly different between the two groups. Conclusions: Gallbladder surgery can be performed in a delayed manner in the deployed service member, although with a significantly higher morbidity as compared with the local population. We suggest that changes in the immediate treatment and transportation of these service members should occur at the theater level. The use of a clinical pathway facilitates the rapid RTD of soldiers diagnosed with gallbladder disease.
KW - Cholecystectomy
KW - Clinical pathway
KW - Gallbladder disease
KW - Military medicine
KW - Operation Enduring Freedom
KW - Operation Iraqi Freedom
KW - Postoperative convalescence
KW - Return to duty
UR - http://www.scopus.com/inward/record.url?scp=71449095373&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=71449095373&partnerID=8YFLogxK
U2 - 10.1007/s00464-009-0480-9
DO - 10.1007/s00464-009-0480-9
M3 - Article
C2 - 19585073
AN - SCOPUS:71449095373
VL - 23
SP - 2702
EP - 2707
JO - Surgical Endoscopy and Other Interventional Techniques
JF - Surgical Endoscopy and Other Interventional Techniques
SN - 0930-2794
IS - 12
ER -