title: A Comparison of Four-Year Health Outcomes following Combat Amputation and Limb Salvage.
abstract: Little research has described the long-term health outcomes of patients who had combat-related amputations or leg-threatening injuries. We conducted retrospective analysis of Department of Defense and Department of Veterans Affairs health data for lower extremity combat-injured patients with (1) unilateral amputation within 90 days postinjury (early amputation, n = 440), (2) unilateral amputation more than 90 days postinjury (late amputation, n = 78), or (3) leg-threatening injuries without amputation (limb salvage, n = 107). Patient medical records were analyzed for four years postinjury. After adjusting for group differences, early amputation was generally associated with a lower or similar prevalence for adverse physical and psychological diagnoses (e.g., pain, osteoarthritis, posttraumatic stress disorder) versus late amputation and/or limb salvage. By contrast, early amputation was associated with an increased likelihood of osteoporosis during the first year postinjury. The prevalence of posttraumatic stress disorder increased for all patient groups over four years postinjury, particularly in the second year. The different clinical outcomes among combat extremity injured patients treated with early amputation, late amputation, or limb salvage highlight their different healthcare requirements. These findings can inform and optimize the specific treatment pathways that address the physical and psychological healthcare needs of such patients over time.
authors.affiliation: Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, California, United States of America.
authors.forename: Ted
authors.identifier: http://orcid.org/0000-0001-8330-6985
authors.initials: T
authors.lastname: Melcer
authors.affiliation: Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, California, United States of America.
authors.forename: Jay
authors.initials: J
authors.lastname: Walker
authors.affiliation: Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, California, United States of America.|VA San Diego Healthcare System, San Diego, California, United States of America.|Department for Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America.
authors.forename: Vibha
authors.initials: V
authors.lastname: Bhatnagar
authors.affiliation: Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, California, United States of America.|VA San Diego Healthcare System, San Diego, California, United States of America.|Department for Family Medicine and Public Health, University of California San Diego, San Diego, California, United States of America.
authors.forename: Erin
authors.initials: E
authors.lastname: Richard
authors.affiliation: VA Minneapolis Healthcare System, Minneapolis, Minnesota, United States of America.
authors.forename: V Franklin
authors.initials: VF
authors.lastname: Sechriest
authors.affiliation: Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, California, United States of America.
authors.forename: Michael
authors.initials: M
authors.lastname: Galarneau
mesh_terms: D000328:Adult; D000671:Amputation, Surgical / Q000009:adverse effects* / Q000523:psychology; D006801:Humans; D015601:Injury Severity Score; D007869:Leg Injuries / Q000523:psychology / Q000601:surgery*; D008297:Male; D010024:Osteoporosis / Q000209:etiology / Q000523:psychology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology / Q000523:psychology; D015995:Prevalence; D011379:Prognosis; D020127:Recovery of Function; D013313:Stress Disorders, Post-Traumatic / Q000209:etiology / Q000523:psychology; D013530:Surgical Wound Infection / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D014481:United States; D055815:Young Adult