American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Military Surgeons Release Largest Report of U.S. Military Humanitarian Medical Care Delivered in Afghanistan

New report is the first to characterize the scope of care and resources directed toward local patients


WASHINGTON, DC (Tuesday, October 18, 2016): In the largest and most comprehensive report of surgical humanitarian care rendered in U.S. military treatment facilities in Afghanistan, researchers found that 49 percent of civilian patients were treated for non-war-related conditions. The research team from the Walter Reed National Military Medical Center and the Uniformed Services University of the Health Sciences, both located in Bethesda, Md., presented their findings today during the 2016 Clinical Congress of the American College of Surgeons.

“We conducted this research because up until now we didn’t have any studies that described the larger, in-theater experience of what kind of injuries and diseases we were treating and what procedures we were performing in terms of the local civilian population,” explained Sharon R. Weeks, MD, lead study author and general surgery resident at Walter Reed National Military Medical Center.

According to study authors, who looked at U.S. military adult humanitarian care in Afghanistan from 2002 to 2013, 10,705 local civilian patients were treated, of which 5,786 underwent at least one medical or surgical procedure. Of the group that had at least one procedure, 80.9 percent were male. Researchers used information from the U.S. Army Patient Administration Systems and Biostatistics Activity and analyzed patient records separately based on their presentation for war-related injuries.

Among the research team’s findings was an identification of the most common procedures performed on patients for both war-related and non-war-related causes of injury. For the war-related group, the most common procedures performed were excisional wound debridement (748 procedures), chest tube placement (124 procedures), free skin graft (98 procedures), temporary tracheostomy (96 procedures), and below knee amputation (84 procedures). For the non-war-related group, the most common procedures were excisional wound debridement (341 procedures), free skin graft (122 procedures), ORIF femur (92 procedures), ORIF tibia-fibula (87 procedures), and temporary tracheostomy (72 procedures).

Dr. Weeks said that within the period of 2002 to 2013, there was some fluctuation in the type of treatment being provided. She also said the fluctuation was related to the resources that were available. “I thought that when there was an uptick in war-related procedures, there would be a downtick in non-war-related procedures. But that expectation didn’t pan out, which likely occurred because when there is an increase in war-related injuries, there is an increase in the resources that become available.”

The researchers found patients came in with war-related injuries tended to be younger, with a median age of 26 years, while those with non-war-related injuries had a median age of 29 years. Further, 943 (32.2 percent) of the patients with war-related injuries required a blood transfusion, while only 363 (12.7 percent) of the non-war-related patients required a blood transfusion.

“These results reflect a strong commitment to provide care to those in medical need as well as a requirement for education on the principles of global surgery for deployed military surgeons,” noted the study authors.

Dr. Weeks said that there is much in common between global surgery and the care provided in military treatment facilities. The researchers found that patients who came to the treatment facility for non-war-related reasons came to be treated for injuries.

“For anyone familiar with global health and global surgery, we know that injury in the developing world is a huge source of morbidity and mortality,” Dr. Weeks said. “This finding tracks well what has been reported in global health in other settings.”

An understanding that the surgical field and the military have much in common is the basis for the Military Health System Strategic Partnership American College of Surgeons (MHSSPACS)—launched in October 2014—which facilitates the collaboration and exchange of information between the ACS and the Military Health System.

“Most Americans are unaware of the tremendous amount of humanitarian work that is being offered by our deployed military surgeons,” said M. Margaret (Peggy) Knudson, MD, FACS, Medical Director, MHSSPACS. “Because trauma surgery is one of the disciplines most needed globally, the educational efforts under development via the MHSSPACS will ensure that military surgeons of the future are well versed in caring for the injured.”

Other study participants included John S. Oh, MD, FACS, and Peter A. Learn, MD, FACS.

Note: Views expressed in this press release are those of the authors and do not reflect the official policy or position of the U.S. Army, U.S. Air Force, Department of Defense and/or the U.S. Government.

# # #

About the American College of Surgeons
The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for all surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. For more information, visit


Sally Garneski 
Dan Hamilton