Impact of International Department of Defense Surgical Missions on Readiness: Perspectives from Military Surgeons.

Introduction: Declining surgical case volumes in the Military Healthcare System have raised concerns about the readiness of Department of Defense (DoD) surgeons for deployment. Reduced opportunities for major surgeries at Military Treatment Facilities correlate with declines in surgical Knowledge, Skills, and Abilities metrics, which measures deployment preparedness. This challenge, termed the "Walker Dip," is exacerbated during peacetime. International surgical missions and military Global Health Engagement (GHE) have been proposed to bridge this gap by offering military surgeons the chance to manage complex cases in low-resource settings. Although GHE missions aim to strengthen global partnerships and improve interoperability, their direct impact on readiness remains unclear. This study evaluates military surgeons' perceptions of readiness following participation in DoD surgical missions to better inform future mission planning.

Materials and methods: An anonymous, voluntary survey was developed by medical students and military surgeons with GHE experience. Eligible participants were military surgeons with experience in DoD international surgical missions, excluding combat deployments and disaster response missions. The survey collected demographic data, mission characteristics, and participants' perceived readiness using Likert scales. Data analysis included descriptive statistics, chi-square tests, and Spearman's rank correlations.

Results: A total of 47 respondents met the inclusion criteria. The majority were general surgeons (72%), with 57% serving in the Navy. Fifty-five percent of participants rated the missions helpful to their readiness, while 44.7% were neutral or found them unhelpful. Key factors associated with mission helpfulness included managing complex cases, treating critically ill patients, and performing blood transfusions (P < .05). Although case complexity significantly correlated with perceived readiness (P = .002), case volume did not (P = .109). Navy surgeons were less likely to rate missions as helpful compared to Army and Air Force surgeons (P = .002).

Conclusion: This study highlights the critical role of case complexity and exposure to high-acuity patients in enhancing surgical readiness. International surgical mission planning for readiness should prioritize complexity and operational relevance over procedural volume. Further, optimizing mission design will ensure readiness and preparedness for future deployments while balancing global health and military objectives. Future research should explore standardized metrics to evaluate readiness and the long-term impact and ethical implications of these missions.