Assessment of hospital workload in war surgery.

The aim of treatment of casualties in war time is to offer a chance of survival to the greatest number of patients. This goal can be approached by selecting for treatment patients who have a real chance of survival and by reducing the duration of operations as much as possible. Should the operative time be limited to an assessed predetermined duration as proposed in certain armies? Conditions for the observation of war wounded were particularly favourable in the ICRC (International Committee of the Red Cross) Hospital in Peshawar (Pakistan) because all treatments were started and completed in the same place. During the summer of 1985, a major battle took place near the Pakistan border. Analysis of 212 operated patients, of whom 68 per cent arrived at the hospital less than 48 h after the injury, showed that the operations lasted 90 min on average. Abdominal procedures were the longest. Patients stayed in the hospital for an average of 4 weeks; those with lesions of the extremities stayed longer (5.8 weeks) than those with abdominal or thoracic lesions (4.3 and 3 weeks). The results show that the long duration of an operation has not been correlated either with an unfavourable outcome or with an increased postoperative workload. As far as possible, accelerating the turnover of operations by increasing the number of operating teams should be the objective rather than the selection of patients who require short operations. Such selection would have resulted in the death of most seriously wounded patients in this series.