Trends in Surgical Volume in the Military Health System—A Potential Threat to Mission Readiness

ABSTRACT Introduction The Military Health System (MHS) is tasked with a dual mission both to provide medical services for covered patients and ensure that its active duty personnel maintain readiness deployment. Knowledge, skills, attitudes (KSA) metric evaluating the transferrable skills incorporated into given surgery or procedure are most relevant surgeons deployed theatre of war. Procedures carrying high KSA value those utilizing relevance maintaining deployment readiness. Given ongoing concerns regarding surgical volumes at MTFs potential adverse impact on military surgeon were high-value surgeries be lost civilian sector, we evaluated trends in setting beneficiaries within MHS. Methods We retrospectively analyzed inpatient admissions data from TRICARE claims hospitals, 2005-2019, identify TRICARE-covered under “purchased care” (referred facilities) receiving “direct (undergoing treatment MTFs) undergoing seven high-value/high-KSA surgeries: colectomy, pancreatectomy, hepatectomy, open carotid endarterectomy, abdominal aortic aneurysm (AAA) repair, esophagectomy, coronary artery bypass grafting (CABG). Overall procedure-specific counts captured, categorized quartiles by volume, independence between was tested Cochran–Armitage test, hypothesizing proportion cases referred purchased care increasing. Results captured 292,411 cases, including 7,653 pancreatectomies, 4,177 hepatectomies, 3,815 esophagectomies, 112,684 colectomies, 92,161 CABGs, 26,893 AAA repairs, 45,028 endarterectomies. majority included (90.3%), increasing over study period (P < .01). By procedure, all except repairs increasingly (all P .01, esophagectomy = .04). On examining found even highest-volume-quartile performed median less than one pancreatectomy per month. only once month more CABG. Conclusion volume referral MHS, low vast an hospitals last 15 years. Our findings illustrate missed opportunities personnel. Prioritizing recapture may improve teams’