(0311) Effect of Subspecialty Training on United States Military Otolaryngologist’s Surgical Workload in Bagram, Afghanistan: 2016–2020

Introduction: The purpose of this study is to describe the US military otolaryngologist’s surgical workload at a single role 3 facility from 2016 to 2020 and to investigate if subspecialty experience impacted caseload.

Methods: This study is a descriptive analysis of the surgical caseload performed by deployed US military otolaryngologists at Bagram Air Base from 2016 to 2020. The operative logs were compiled into a database of 1,205 procedures. Data analysis involved trending, descriptive statistics, and a chi square analysis. Outcomes consisted of category of cases over time and the mix of case type by surgeon.

Results: Facial trauma comprised 52% (626/1,205) of all procedures. The remaining procedures treated disease or were elective surgery, accounting for 48% (579/1,205) of procedures and ranging annually from 38% to 62%. Of these, 16% were categorized as comprehensive otolaryngology, 8% as facial plastics/reconstruction, 3% as otology, 3% as laryngology, 1% as rhinology, and <1% as head and neck and sleep surgery. Of all procedures, 16% (193/1205) were cases assisting other surgical services. Of the US military otolaryngologists deployed, 47% (7/15) were surgical subspecialists. Subspecialties represented were facial plastics/reconstruction, otology, rhinology, sleep surgery, and pediatric otolaryngology. When comparing the generalist’s case mix to each subspecialist’s, there was a significant difference found for those trained in facial plastics (p = 0.001), pediatric otolaryngology (p < 0.001), and sleep surgery (p < 0.001). None of these three subspecialties reflected a shift towards their own subspecialty.

Conclusions: The surgical workload of a US military otolaryngologist deployed to a role 3 setting in Bagram, Afghanistan from 2016 to 2020 consistently involved a large percentage of procedures that treat disease and covered a comprehensive breadth of otolaryngology. There were significant differences in case mixes between generalists and some subspecialists. However, this difference was not a trend towards the surgeon’s subspecialty, indicating there is no subspecialist preference in a deployed role 3 setting.