Longitudinal analysis of 15-year health outcomes after combat-related lower limb amputation: A retrospective study

Abstract: BACKGROUND: Limited longitudinal research has been conducted on health outcomes during the first 15 years after combat-related lower limb amputation. METHODS: This retrospective analysis of Departments of Defense and Veterans Affairs health data included casualty records of 4,814 service members who sustained either a single traumatic (n = 612) or delayed (n = 427) lower limb amputation or moderate/serious lower limb injury without amputation (n = 3,775) in Operations Iraqi and Enduring Freedom 2001-2017. Outcomes were clinical diagnoses during the first 15 years postinjury, including pain-related, behavioral health, cardiovascular, and bone disorders. Longitudinal analyses tested for associations between injury group and postinjury years and interactions between injury group and postinjury years and outcomes. RESULTS: The results showed high prevalence of diagnostic outcomes, particularly early postinjury pain and behavioral health diagnoses following amputation. Longitudinal analyses generally showed significant decreases in prevalence of outcomes, although some persisted at substantial rates (pain, insomnia, depression) or increased during later postinjury years (osteoarthritis, cardiovascular disorders, posttraumatic stress disorder). After adjusting for covariates, longitudinal analyses showed significant interactions between amputation groups (versus limb injury) and postinjury years. During early postinjury years, amputation generally was associated with significantly more total diagnoses and higher odds ratios for pain, behavioral health, and bone diagnoses. During later postinjury years 10 to 15, however, traumatic amputation was associated with significantly fewer total diagnoses and similar or lower rates for pain and behavioral health diagnoses. CONCLUSION: The results indicate that traumatic and delayed lower limb amputations were associated with different longitudinal patterns for some pain-related, behavioral health, and bone disorders during the first 15 years postinjury. Amputation was associated with marginally higher rates of diabetes but not hypertension, lipidemia, or obesity. These results can inform clinical guidelines for postinjury treatment pathways, including multidisciplinary amputation care for many years postinjury. LEVEL OF EVIDENCE: Retrospective/Epidemiologic; Level IV.