Surgical care at sea: A retrospective review of the maritime surgical and quality improvement database.

Abstract

Surgical care aboard US Navy warships is delivered in a uniquely austere and operationally complex environment characterized by limited diagnostic resources, constrained evacuation options, and independent surgical practice within an active weapons platform. Despite its importance to military medical readiness, objective outcomes-based evaluations of surgical care performed at sea remain limited. We performed a retrospective review of a prospectively maintained Maritime Surgery and Quality Improvement database from February 2021 through December 2024, supplemented by longitudinal outcome data from the electronic medical record. Operative cases performed at sea were analyzed to characterize case mix, complication rates, and short and long-term outcomes. Complications were assessed intraoperatively, within 30 days, and up to one year following surgery when electronic follow-up was available. A total of 839 entries were recorded, including 322 operative cases and 22 nonoperative patients requiring MEDEVAC. Operative procedures encompassed a broad range of general surgical, orthopedic, gynecologic, urologic, and endoscopic pathology. Maritime surgeons managed both routine and high-acuity conditions, frequently outside traditional general surgery scope, in the absence of subspecialty support. Among operative cases, one intraoperative complication (0.3%) and 24 early postoperative complications (7.1%) were observed. Delayed complications occurred in 11 patients (5.3%) with available long-term follow-up. No deaths were attributed to surgical complications. Selected higher-acuity procedures, including laparoscopic cholecystectomy and diagnostic laparoscopy, were successfully performed at sea in carefully selected patients. In this multiyear, multiplatform cohort, carefully selected surgical interventions were performed safely at sea across a wide range of operative pathologies, with complication rates comparable to civilian benchmarks despite significant resource constraints. These findings provide objective data to inform operative decision-making, support surgeon-command risk assessment, and guide the development of evidence-informed clinical practice guidelines for surgical care in the deployed maritime environment. (J Trauma Acute Care Surg. 2026;00:00-00. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Level IV.