Flagship response: a descriptive analysis of definitive surgical care at the Walter Reed National Military Medical Center following the Afghanistan withdrawal

Objectives: We descriptively analyzed the trauma care outcomes of combat casualties arriving at the Walter Reed National Military Medical Center (WRNMMC) following the 2021 Afghanistan withdrawal as part of process improvement (PI) initiatives and quality assurance. Methods: A retrospective review of casualty records within the trauma registry at WRNMMC was conducted. The review included all patients who required definitive surgical intervention or critical care at WRNMMC from injuries sustained during the Afghanistan withdrawal. Data abstraction involved a detailed review of electronic medical records to document patient demographics, injury mechanisms, Injury Severity Scores (ISSs), operative reports, perioperative complications, and outcomes. Results: A total of 50 casualties were received at WRNMMC after the Afghanistan withdrawal, including 17 US military service members and 33 Afghan evacuees (20 adults and 13 pediatric). The mean ISS for US service members was 16.3±14.3. The mean ISS of Afghan evacuees was 10.7±6.1 for adults and 16.6±13.3 for pediatric evacuees. Polytrauma was common, with a majority of casualties sustaining injuries to multiple body regions. A total of 234 injuries were seen, with an average of 4.68±3.8 injuries per casualty. 264 operations were performed, averaging 5.2±5.6 per casualty. 23 postsurgical complications occurred in 10 casualties. 28 PI filters were initiated on 22 casualties. Caring for the casualties required multidisciplinary cooperation led by the trauma and acute care surgery service. Conclusion: The trauma care provided at WRNMMC following the Afghanistan withdrawal demonstrated institutional readiness and effective multidisciplinary coordination, but with a sizable burden of postoperative complications and PI filters. Lessons from this experience highlight the importance of continuous PI to optimize care delivery and outcomes, and underscore the need to sustain WRNMMC and strengthen other casualty-receiving Military Treatment Facilities to preserve trauma care readiness for future conflict. Level of evidence: Therapeutic/care management; level V.