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A comparison of health outcomes for combat amputee and limb salvage patients injured in Iraq and Afghanistan wars

Melcer, Ted PhD; Sechriest, Vernon Franklin MD; Walker, Jay BA; Galarneau, Michael MS, NREMT

Journal of Trauma and Acute Care Surgery: August 2013 - Volume 75 - Issue 2 - p S247–S254
doi: 10.1097/TA.0b013e318299d95e
Clinical Science: Clinical Outcomes

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.

CONCLUSION 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.

LEVEL OF EVIDENCE Epidemiologic and prognostic study, level III.

From the Medical Modeling, Simulation, and Mission Support Department (T.M., J.W., M.G.), Naval Health Research Center; and Orthopedic Medical Group of San Diego (V.F.S.), San Diego, California.

Submitted: November 20, 2012, Revised: March 11, 2013, Accepted: April 1, 2013.

This represents report 12-43 supported by The Bureau of Medicine Wounded, Ill, and Injured Program, under work unit no. 61110. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government. Approved for public release; distribution is unlimited. This research was conducted in compliance with all applicable federal regulations governing the protection of human subjects (NHRC IRB protocol 2007.0016).

Address for reprints: Ted Melcer PhD, Medical Modeling, Simulation, and Mission Support Department, Naval Health Research Center, 140 Sylvester Rd, San Diego, CA 92106-3521; email:

© 2013 Lippincott Williams & Wilkins, Inc.