title: A comparison of health outcomes for combat amputee and limb salvage patients injured in Iraq and Afghanistan wars.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, San Diego, California 92106-3521, USA. ted.melcer@med.navy.mil
authors.forename: Ted
authors.initials: T
authors.lastname: Melcer
authors.forename: Vernon Franklin
authors.initials: VF
authors.lastname: Sechriest
authors.forename: Jay
authors.initials: J
authors.lastname: Walker
authors.forename: Michael
authors.initials: M
authors.lastname: Galarneau
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000671:Amputation, Surgical / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D007869:Leg Injuries / Q000601:surgery*; D023821:Limb Salvage / Q000009:adverse effects / Q000523:psychology / Q000706:statistics & numerical data; D008887:Military Medicine / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult