{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,21]],"date-time":"2025-09-21T07:15:08Z","timestamp":1758438908384,"version":"3.44.0"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"Supplement_2","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Conflicts related to Operation Iraqi Freedom (OIF) led to nearly 32,000 wounded U.S. service members, with thoracic injuries seen in 8.6% of casualties. Our aim was to better understand the effects of deployed cardiothoracic surgeons.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A retrospective analysis of DoD Trauma Registry data was performed. Inclusion criteria included U.S. service members with thoracic trauma that sought care at the role 3 hospital at Balad and received a cardiothoracic procedure from 2004 to 2011 during OIF. Deployment timelines were established to determine when a U.S. Air Force cardiothoracic surgeon was present at Balad. Patients that met inclusion criteria were divided 2 two cohorts based on the presence of a cardiothoracic surgeon. Clinical outcomes were assessed and compared between the 2 cohorts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>One hundred and nine patients met inclusion criteria; 93.6% (n\u2009=\u2009102) of these patients were treated at Balad when a cardiothoracic surgeon was present and 6.4% (n\u2009=\u20097) when a cardiothoracic surgeon was not present. Ninety-eight percent of all patients from both cohorts were male and the most common mechanism of injury was penetrating (58.7%, n\u2009=\u200964). Average Injury Severity Score of patients when a cardiothoracic surgeon was present was 27.6 and when one was not was 29.4 (P-value .73). The most common injury observed between both cohorts was a pneumothorax and the most common thoracic procedure performed at Balad was bronchoscopy followed by chest tube placement. Mortality rate of 9.8% was observed in the cohort where a cardiothoracic surgeon was present and 14.3% in the cohort where a cardiothoracic surgeon was not present (P-value .70).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A U.S. Air Force cardiothoracic surgeon was present at Balad for a large percentage of the time during OIF. The severity\/distribution of patient injury and clinical outcomes appeared similar when a cardiothoracic surgeon was present\/not present.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaf157","type":"journal-article","created":{"date-parts":[[2025,4,12]],"date-time":"2025-04-12T17:13:42Z","timestamp":1744478022000},"page":"268-273","source":"Crossref","is-referenced-by-count":0,"title":["Effect of Deployed Cardiothoracic Surgeons on Clinical Outcomes in U.S. Service Members with Thoracic Trauma in Operation Iraqi Freedom"],"prefix":"10.1093","volume":"190","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0014-4974","authenticated-orcid":false,"given":"Timothy M","family":"Guenther","sequence":"first","affiliation":[{"name":"Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health , Madison, WI 53705,","place":["United States"]},{"name":"David Grant Medical Center Department of Cardiothoracic Surgery, , Travis Air Force Base, CA 94533,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malcolm M","family":"DeCamp","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health , Madison, WI 53705,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J","family":"Moulton","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Nebraska Medical Center , Omaha, NE 68198","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua D","family":"Gustafson","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, San Antonio Military Medical Center , San Antonio, TX 78234,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,9,16]]},"reference":[{"key":"2025091919341202000_R1","first-page":"1","article-title":"US and coalition casualties in Iraq and Afghanistan","author":"Lutz","year":"2013","journal-title":"Watson Inst Strateg Stud Brown Univ"},{"issue":"6","key":"2025091919341202000_R2","doi-asserted-by":"crossref","first-page":"S431","DOI":"10.1097\/TA.0b013e3182755dcc","article-title":"Death on the battlefield (2001\u20132011): implications for the future of combat casualty care","volume":"73","author":"Eastridge","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"issue":"2","key":"2025091919341202000_R3","doi-asserted-by":"crossref","first-page":"91","DOI":"10.1177\/1531003506293374","article-title":"Echelons of care and the management of wartime vascular injury: a report from the 332nd EMDG\/Air Force Theater Hospital, Balad Air Base, Iraq","volume":"18","author":"Rasmussen","year":"2006","journal-title":"Perspect Vasc Surg Endovasc Ther"},{"issue":"10","key":"2025091919341202000_R4","doi-asserted-by":"crossref","first-page":"S7","DOI":"10.5435\/00124635-200600001-00003","article-title":"Levels of medical care in the global war on terrorism","volume":"14","author":"Bagg","year":"2006","journal-title":"J Am Acad Orthop Surg"},{"key":"2025091919341202000_R5","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/s13665-016-0148-6","article-title":"The critical care air transport experience","volume":"5(5)","author":"Crawley","year":"2016","journal-title":"Curr Pulmonol Rep"},{"issue":"6","key":"2025091919341202000_R6","doi-asserted-by":"crossref","first-page":"S514","DOI":"10.1097\/TA.0b013e3182754654","article-title":"Thoracic injuries in US combat casualties: a 10-year review of Operation Enduring Freedom and Iraqi Freedom","volume":"73","author":"Ivey","year":"2012","journal-title":"J Trauma Acute Care Surg"},{"issue":"2","key":"2025091919341202000_R7","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.athoracsur.2013.04.033","article-title":"Utilization of cardiothoracic surgeons for operative penetrating thoracic trauma and its impact on clinical outcomes","volume":"96","author":"Mollberg","year":"2013","journal-title":"Ann Thorac Surg"},{"key":"2025091919341202000_R8","doi-asserted-by":"crossref","first-page":"368","DOI":"10.1016\/j.annemergmed.2012.12.015","article-title":"Change of shift. 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