BACKGROUND Fellowship-trained orthopaedic oncologists in the US military provide routine clinical care and also must maintain readiness to provide combat casualty care. However, low oncologic procedure volume may hinder the ability of these surgeons to maintain relevant surgical expertise. Other low-volume specialties within the Military Health System (MHS) have established partnerships with neighboring civilian centers to increase procedure volume, but the need for similar partnerships for orthopaedic oncologists has not been examined. The purpose of this study was to characterize the practice patterns of US military fellowship-trained orthopaedic oncologists. QUESTIONS/PURPOSES We asked the following questions: (1) What are the diagnoses treated by US military fellowship-trained orthopaedic oncologists? (2) What are the procedures performed by US military fellowship-trained orthopaedic oncologists? METHODS We queried the Military Data Repository, a centralized repository for healthcare data for all healthcare beneficiaries (active duty, dependents, and retirees) within the Defense Health Agency using the MHS's Management and Reporting Tool for all international common procedure taxonomy (CPT) codes and ICD-9 and ICD-10 codes associated with National Provider Identifier (NPI) numbers of active duty, military fellowship-trained orthopaedic oncologists. Fellowship-trained orthopaedic oncologists were identified by military specialty leaders. Then, we identified all procedures performed by the orthopaedic oncologist based on NPI numbers for fiscal years 2013 to 2022. We stratified the CPT codes by top orthopaedic procedure categories (such as amputation [performed for oncologic and nononcologic reasons], fracture, arthroplasty, oncologic) based on associated ICD codes. These were then tabulated by the most common diagnoses treated. RESULTS Thirteen percent (796 of 5996) of the diagnoses were oncologic, of which 45% (357 of 796) were malignant. Forty-four percent (158 of 357) of the malignancies were primary and 56% (199 of 357) were secondary; this translates to an average of 2 patients with primary and 2.5 patients with secondary malignancies treated per surgeon per year. During the study period, nine orthopaedic oncologists performed 5996 orthopaedic procedures, or 74 procedures per surgeon per year. Twenty-one percent (1252 of 5996) of the procedures were oncologic; the remaining procedures included 897 arthroplasties, 502 fracture-related, 275 amputations for a nononcologic indication, 204 infections, 142 arthroscopic, and 2724 other procedures. CONCLUSION Although military orthopaedic oncologists possess expert skills that are directly translatable to combat casualty care and operational readiness, within MHS hospitals they treat relatively few patients with oncologic diagnoses, and less than one-half of those involve malignancies. CLINICAL RELEVANCE Despite postgraduation procedure volume raining stable over the last decade, it is unknown how many new patient visits for oncologic diagnoses and how many corresponding tumor procedures are necessary to maintain competence or build confidence after musculoskeletal oncology fellowship training. It is important to note that there are no military orthopaedic oncology fellowships, and all active duty orthopaedic oncologists undergo training at civilian institutions. Military-civilian partnerships with high-volume cancer centers may enable military orthopaedic oncologists to work at civilian cancer centers to increase their oncologic volume to ensure sustainment of operationally relevant knowledge, skills, and abilities and improve patient care and outcomes.

中文翻译：

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在军队环境中执业的受过奖学金教育的军事骨科肿瘤学家是否治疗了足够数量的患者以保持他们的肿瘤学专业知识？


背景 美国军队中受过奖学金培训的骨科肿瘤学家提供常规临床护理，还必须随时准备提供战斗伤员护理。然而，低肿瘤手术量可能会阻碍这些外科医生保持相关手术专业知识的能力。军事卫生系统 （MHS） 内的其他低容量专业已与邻近的文职中心建立了合作伙伴关系，以增加手术量，但尚未检查骨科肿瘤学家建立类似合作伙伴关系的必要性。本研究的目的是描述受过美国军方奖学金培训的骨科肿瘤学家的实践模式。问题/目的 我们询问了以下问题： （1） 受过美国军方奖学金培训的骨科肿瘤学家治疗哪些诊断？（2） 受过美国军方奖学金培训的骨科肿瘤学家执行哪些程序？方法 我们查询了军事数据存储库，这是一个国防卫生局内所有医疗保健受益人（现役、家属和退休人员）的医疗保健数据的集中式存储库，使用 MHS 的管理和报告工具获取所有国际通用程序分类法 （CPT） 代码以及与现役国家提供者标识符 （NPI） 编号相关的 ICD-9 和 ICD-10 代码， 受过军事奖学金培训的骨科肿瘤学家。受过奖学金培训的骨科肿瘤学家由军事专业领导者确定。然后，我们根据 2013 年至 2022 财年的 NPI 数字确定了骨科肿瘤学家执行的所有程序。我们根据相关的 ICD 代码按主要骨科手术类别 （例如截肢 [因肿瘤和非肿瘤原因进行]、骨折、关节置换术、肿瘤）对 CPT 代码进行分层。 然后按治疗的最常见诊断将这些值列成表格。结果 13% （5996 例中的 796 例） 的诊断是肿瘤性的，其中 45% （796 例中的 357 例） 是恶性的。44%（357 例中的 158 例）是原发性肿瘤，56%（357 例中的 199 例）是继发性肿瘤;这意味着每位外科医生每年平均治疗 2 名原发性恶性肿瘤患者和 2.5 名继发性恶性肿瘤患者。在研究期间，9 名骨科肿瘤学家进行了 5996 例骨科手术，或每位外科医生每年进行 74 例手术。21% （1252/5996） 的手术是肿瘤手术;其余手术包括 897 例关节置换术、502 例骨折相关手术、275 例非肿瘤适应症截肢手术、204 例感染、142 例关节镜手术和 2724 例其他手术。结论 尽管军事骨科肿瘤学家拥有可直接转化为对抗伤员护理和作战准备的专业知识，但在 MHS 医院内，他们治疗相对较少的肿瘤诊断患者，其中不到一半涉及恶性肿瘤。临床相关性 尽管在过去十年中毕业后手术量保持稳定，但尚不清楚有多少新患者就诊进行肿瘤学诊断，以及在肌肉骨骼肿瘤学奖学金培训后需要多少相应的肿瘤手术来保持能力或建立信心。需要注意的是，没有军事骨科肿瘤学奖学金，所有现役骨科肿瘤学家都在民用机构接受培训。 与高容量癌症中心的军民合作伙伴关系可能使军事骨科肿瘤学家能够在民用癌症中心工作，以增加其肿瘤容量，以确保维持与手术相关的知识、技能和能力，并改善患者护理和结果。