{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,24]],"date-time":"2026-01-24T17:04:26Z","timestamp":1769274266245,"version":"3.49.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"7-8","license":[{"start":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T00:00:00Z","timestamp":1641340800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,22]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Sustaining critical wartime skills (CWS) during interwar periods is a recurrent and ongoing challenge for military surgeons. Amputation surgery for major extremity trauma is exceptionally common in wartime, so maintenance of surgical skills is necessary. This study was designed to examine the volume and distribution of amputation surgery performed in the military health system (MHS).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Study Design<\/jats:title>\n                  <jats:p>All major amputations performed in military treatment facilities (MTF) for calendar years 2017\u20132019 were identified by current procedural terminology (CPT) codes. The date of surgery, operating surgeon National Provider Identifier, CPT code(s), amputation etiology (traumatic versus nontraumatic), and beneficiary status (military or civilian) were recorded for each surgical case.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>One thousand one hundred and eighty-four major amputations at 16 of the 49 military\u2019s inpatient facilities were identified, with two MTFs accounting for 46% (548\/1,184) of the total. Six MTFs performed 120 major amputations for the treatment of acute traumatic injuries. Seventy-three percent (87\/120) of traumatic amputations were performed at MTF1, with the majority of patients (86%; 75\/87) being civilians emergently transported there after injury. Orthopedic and vascular surgeons performed 78% of major amputations, but only 9.7% (152\/1,570) of all military surgeons performed any major amputation, with only 3% (52) involved in amputations for trauma. Nearly all (87%; 26\/30) of the orthopedic surgeons at MTF1 performed major amputations, including those for trauma.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>This study highlights the importance of civilian patient care to increase major amputation surgical case volume and complexity to sustain critical wartime skills. The preservation and strategic expansion of effective military\u2013civilian partnerships is essential for sustaining the knowledge and skills for optimal combat casualty care.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usab534","type":"journal-article","created":{"date-parts":[[2022,1,5]],"date-time":"2022-01-05T17:11:25Z","timestamp":1641402685000},"page":"e1362-e1366","source":"Crossref","is-referenced-by-count":2,"title":["Impact of Civilian Patient Care on Major Amputation Case Volume in the Military Health System"],"prefix":"10.1093","volume":"188","author":[{"given":"Dawn M G","family":"Rask","sequence":"first","affiliation":[{"name":"Business Operations Division, Brooke Army Medical Center , Fort Sam Houston, TX 78234, USA"},{"name":"Department of Orthopaedic Surgery, San Antonio Uniformed Services Health Education Consortium , Fort Sam Houston, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly A","family":"Tansey","sequence":"additional","affiliation":[{"name":"Business Operations Division, Brooke Army Medical Center , Fort Sam Houston, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick M","family":"Osborn","sequence":"additional","affiliation":[{"name":"Business Operations Division, Brooke Army Medical Center , Fort Sam Houston, TX 78234, USA"},{"name":"Department of Orthopaedic Surgery, San Antonio Uniformed Services Health Education Consortium , Fort Sam Houston, TX 78234, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2022,1,5]]},"reference":[{"key":"2023072301084532600_R1","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1001\/jamasurg.2019.0151","article-title":"Use of combat casualty care data to assess the US military trauma system during the Afghanistan and Iraq Conflicts, 2001-2017","volume":"154","author":"Howard","year":"2019","journal-title":"JAMA 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