A Retrospective Comparison of Five‐Year Health Outcomes Following Upper Limb Amputation and Serious Upper Limb Injury in the Iraq and Afghanistan Conflicts

Abstract

Background: Limited population-based research has described long-term health outcomes following combat-related upper limb amputation. Objective: To compare health outcomes following upper limb amputation with outcomes following serious upper limb injury during the first 5 years postinjury. Design: Retrospective cohort. Setting: Departments of Defense (DoD) and Veterans Affairs (VA) inpatient and outpatient health care facilities. Participants: Three-hundred eighteen U.S. Service Members. Methods: Patients sustained an above elbow (AE, n = 51) or below elbow (BE, n = 80) amputation or serious arm injury without amputation (NO AMP, n = 187) in the Iraq or Afghanistan conflicts, 2001 through 2008. Injuries were coded by trauma nurses. Outcomes came from DoD and VA health databases. Main Outcome Measurements: International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes. Results: Most patients were injured by blast weaponry causing serious to severe injuries. All groups had a high prevalence of physical and psychological health diagnoses. The prevalence for nearly all wound complications and many physical and psychological disorders decreased substantially after postinjury year 1. The prevalence of posttraumatic stress disorder, however, increased significantly from postinjury year 1 (20%) to 3 (36%). Pain and psychological disorders ranged from 69% to 90% of patients during postinjury year 1 and remained relatively high even postinjury during year 5 (37%-53%). After adjusting for covariates, the AE group had significantly higher odds for some physical and psychological diagnoses (eg, deep vein thrombosis/pulmonary embolism, cervical pain, osteoarthritis, obesity, and mood and adjustment disorders) relative to the BE or NO AMP groups. BE patients had significantly lower odds for osteomyelitis, and AE and BE patients had lower odds for fracture nonunion and joint disorders versus NO AMP. Conclusions: The results identify similarities and differences in clinical outcomes following combat-related upper limb amputation versus serious arm injury and can inform medical planning to improve rehabilitation programs and outcomes for these patients.Patients with combat-related above-elbow amputation had five times higher odds than patients with serious arm injury without amputation for developing: a. Anemia b. Deep vein thrombosis/Pulmonary Embolism c. Infection d. Arthritis

All‐cause and cause‐specific mortality rates after severe extremity injuries among previously deployed active duty service members

“…Previous research has shown that active duty military personnel who sustain extremity injuries while in service are at elevated risk for serious physical and psychological health issues that could affect their long-term functioning and quality of life, [6][7][8][9][10][11][12][13][14][15][16] yet no prior studies have examined longer-term mortality in this population. This study addressed this knowledge gap by examining all-cause and cause-specific mortality rates among service members who sustained serious extremity injuries while in service.…”

“…Numerous physical comorbidities are associated with extremity injuries, including weight gain, lingering pain, joint disorders, and cardiovascular disease, as well as associated risk factors, such as metabolic syndrome. [6][7][8][9][10][11][12][13][14][15][16] Further, evidence suggests that rates of psychological disorders, such as posttraumatic stress disorder and depression, are high following extremity injury, including injuries that required amputations. [17][18][19] Although morbidity has been well characterized among individuals with severe extremity injuries, [6][7][8][9][10][12][13][14][15][16][17][18] mortality has been understudied.…”

“…[6][7][8][9][10][11][12][13][14][15][16] Further, evidence suggests that rates of psychological disorders, such as posttraumatic stress disorder and depression, are high following extremity injury, including injuries that required amputations. [17][18][19] Although morbidity has been well characterized among individuals with severe extremity injuries, [6][7][8][9][10][12][13][14][15][16][17][18] mortality has been understudied. Most studies of mortality in injured populations focus on short-term mortality as a metric of injury survival (ie, perioperative mortality).…”

Acute stress disorder in patients with accidental traumatic fractures: What can we do

“…Identifying and understanding the influencing factors are very important to the early prevention and nursing care of ASD. Previous studies (Melcer et al, 2019 ; Mona et al, 2019 ) have pointed out that the patient’s trauma history, complications, and degree of trauma can damage important functions of the body, loss of self‐care, self‐reliance, and social function, resulting in more serious ASD. Fear, anxiety and depression during injury can cause brain atrophy (Qiong et al, 2015 ).…”

Prospective cohort study examining the use of regional anesthesia for early pain management after combat-related extremity injury

“…Few studies have routinely captured health outcomes or examined the diverse nature of pain experiences in the 24 months following combat-related injury. 28 Uniquely, this study measured a range of pain-related symptoms from the time of initial injury through recovery. While not statistically significant, individuals receiving early RA reported lower mean neuropathic pain quality and intensity scores as well as higher mean TOPS domain score, such as greater satisfaction with outcomes, compared with those who did not receive early RA.…”