A comparison of health outcomes for combat amputee and limb salvage patients injured in Iraq and Afghanistan wars
Adult
Time Factors
Afghan Campaign 2001-
Substance-Related Disorders
0211 other engineering and technologies
02 engineering and technology
Health Services
Limb Salvage
Amputation, Surgical
3. Good health
Stress Disorders, Post-Traumatic
Young Adult
03 medical and health sciences
Injury Severity Score
0302 clinical medicine
Outcome Assessment, Health Care
Humans
Military Medicine
Iraq War, 2003-2011
Leg Injuries
DOI:
10.1097/ta.0b013e318299d95e
Publication Date:
2013-07-24T21:33:31Z
AUTHORS (4)
ABSTRACT
Treatment of military combatants who sustain leg-threatening injuries remains one of the leading challenges for military providers. The present study provides systematic health outcome data to inform decisions on the definitive surgical treatment, namely amputation versus limb salvage, for the most serious leg injuries.This was a retrospective analysis of health records for patients who sustained serious lower-extremity injuries in the Iraq and Afghanistan conflicts, 2001 to 2008. Patients had (1) amputation during the first 90 days after injury (early amputees, n = 587), (2) amputation more than 90 days after injury (late amputees, n = 84), or (3) leg-threatening injuries without amputation (limb salvage [LS], n = 117). Injury data and health outcomes were followed up to 24 months.After adjusting for group differences, early amputees and LS patients had similar rates for most physical complications. Early amputees had significantly reduced rates of psychological diagnoses (posttraumatic stress disorder, substance abuse) and received more outpatient care, particularly psychological, compared with LS patients. Late amputees had significantly higher rates of many mental and physical health diagnoses, including prolonged infections and pain issues, compared with early amputees or LS patients.Early amputation was associated with reduced rates of adverse health outcomes relative to late amputation or LS in the short term. Most evident was that late amputees had the poorest physical and psychological outcomes. These findings can inform health care providers of the differing clinical consequences of early amputation and LS. These results indicate the need for separate health care pathways for early and late amputees and LS patients.
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