Study of Military Patients Shows Increased Use of Resources for Multiple Amputees

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

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 which
requires significantly more resources than isolated extremity injuries or
amputations,” CDR Mark E. Fleming, DO, MC, USN, said during 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

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 US 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 (IED) 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, use of red blood cell packs, longer stays in intensive
care units and mortality rates compared with patients in the SEA group.
— by Jeff Craven

For More Infomation:

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

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

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.

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