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

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.

LEVEL OF EVIDENCE: III.