title: Treatment of gallbladder disease during operations Iraqi Freedom and Enduring Freedom.
abstract: BACKGROUND
  We examined the outcome after treatment for gallbladder disease in deployed military service members and the impact of instituting a clinical pathway to expedite return to duty (RTD).
  
  
  METHODS
  A retrospective chart review of 97 medically evacuated patients with gallbladder disease was carried out. These patients were evacuated from the field to Landstuhl Regional Medical Center (LRMC), Germany, between March 2003 and November 2004. In October 2003, a clinical pathway was established to facilitate returning these deployed patients back to their combat units. These service members were compared with 90 local patients who underwent the same surgery during the study period.
  
  
  RESULTS
  Twenty-nine patients were treated before the implementation of the clinical pathway. Of those, five had complications, five were converted to open, and 52% returned to their deployed units. After the clinical pathway was established, there were no complications (p = 0.023), two were converted to open (p = 0.002), and 84% returned to duty (p = 0.002). The Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) service members had delayed presentations for definitive treatment. When compared with the local patient group, OIF/OEF surgical cases were more often male (78 vs. 32%, p < 0.001), younger (average 31 vs. 35 years, p < 0.001), and associated with longer operative times (89 vs. 52 min, p < 0.001), and had higher conversion rate to open (7.2 vs. 2.2%, p = 0.17) and higher major complication rate (5.1 vs. 0%, p = 0.06). Time to operation and final pathologic diagnosis were significantly different between the two groups.
  
  
  CONCLUSIONS
  Gallbladder surgery can be performed in a delayed manner in the deployed service member, although with a significantly higher morbidity as compared with the local population. We suggest that changes in the immediate treatment and transportation of these service members should occur at the theater level. The use of a clinical pathway facilitates the rapid RTD of soldiers diagnosed with gallbladder disease.
authors: General Surgery Service, Keesler Medical Center, Keesler AFB, MS, USA. chad.edwards.5@us.af.mil
authors: Chad R
authors: CR
authors: Edwards
authors: James P
authors: JP
authors: Dolan
authors: Raymond
authors: R
authors: Fang
authors: Richard E
authors: RE
authors: Standaert
mesh_terms: D000208:Acute Disease; D000328:Adult; D055826:Afghan Campaign 2001-; D002758:Cholangiography / Q000706:statistics & numerical data; D002763:Cholecystectomy / Q000706:statistics & numerical data*; D017081:Cholecystectomy, Laparoscopic / Q000592:standards; D002764:Cholecystitis / Q000601:surgery; D002908:Chronic Disease; D019091:Critical Pathways; D005260:Female; D005705:Gallbladder Diseases / Q000534:rehabilitation / Q000601:surgery*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel; D020127:Recovery of Function; D012189:Retrospective Studies; D055815:Young Adult