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Study of military patients shows increased use of resources for multiple amputees
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Military personnel who sustained traumatic injuries leading to multiple amputations required significantly more hospital resources including blood products, surgical encounters and days spent in the intensive care unit than those with injuries causing single extremity amputation, according to a recent presentation.
Researchers, including senior author COL Romney C. Andersen, MC, also discovered no significant differences between the groups for overall length of hospital stay, associated injuries and rates of traumatic brain injury.
“Current combat operations have resulted in significant increases in multiple extremity amputees. These patients represent a complex cohort that requires significantly more resources than isolated extremity injuries or amputations,” CDR Mark E. Fleming, DO, MC, USN, said during in his presentation at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. “Knowledge of this increased resource utilization may help surgeons and medical administrators allocate assets at hospitals, both military and civilian, dedicated to caring for this complex and challenging patient population.”
Fleming and his colleagues performed a retrospective review of patients admitted to the former National Naval Medical Center during a 3-year period. Of the 109 patients included in the study, all were men and 99% were U.S. Marines. Investigators found that 63 patients underwent a multiple extremity amputation (MEA) and 98% of this group suffered injuries secondary to an improvised explosive device compared with 80% of single extremity amputees (SEA).
All MEA patients had bilateral lower extremity amputations and more than half had amputations above the knee, according to Fleming. In the MEA group, 54 patients had two limbs amputated, seven patients had three limbs amputated and two patients had four limbs amputated.
The investigators found the MEA group had a significantly higher number of surgical encounters (8.6 ± 3.32 vs. 3.9 ± 2.9), use of red blood cell packs (mean 19.5 ± 18.2 units vs. 6.1 ± 6.03 units), longer stays in intensive care units (mean 9.3 ± 13.7 days vs. 3.7 days) and mortality rates (4% vs. 0%) compared to patients in the SEA group. – by Jeff Craven
References:
- Fleming M, Andersen RC, Waterman SM, Dunne JR, et al. Resource use among multiple extremity amputees injured in combat. Paper #606. Presented at the American Academy of Orthopaedic Surgeons 2012 Annual Meeting. Feb. 7-11. San Francisco.
- Fleming M, Waterman S, Dunne J, et al. Dismounted complex blast injuries: Patterns of injuries and resource utilization associated with the multiple extremity amputee. J Surg Orthop Adv. 2012;21(1):32-37.
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For more information:
- CDR Mark E. Fleming, DO, MC, USN, can be reached at the Walter Reed National Military Medical Center, Department of Orthopedics and Rehabilitation, 8901 Wisconsin Ave., Bethesda, MD 20889; email: mark.e.fleming.mil@health.mil.
- Disclosure: The views expressed in this review are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of the Army, Department of Defense nor the U.S. Government. Fleming has no relevant financial disclosures.
Perspective
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LTC Brett D. Owens, MD
Dr. Fleming and his group are congratulated on this study. Their scientific approach to the care of these service members with the most devastating orthopedic injuries is commendable. Their conclusions are simple and to be expected: patients with multiple extremity amputations consume greater resources than those with single extremity amputations. This data can be used to help the study and care of these complex orthopedic trauma patients.
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