Resource utilization and disability outcome assessment of combat casualties from Operation Iraqi Freedom and Operation Enduring Freedom

J Orthop Trauma. 2009 Apr;23(4):261-6. doi: 10.1097/BOT.0b013e31819dfa04.


Objectives: Injuries are common during combat operations. The high costs of extremity injuries both in resource utilization and disability are well known in the civilian sector. We hypothesized that, similarly, combat-related extremity injuries, when compared with other injures from the current conflicts in Iraq and Afghanistan, require the largest percentage of medical resources, account for the greatest number of disabled soldiers, and have greater costs of disability benefits.

Design: Descriptive epidemiologic study and cost analysis.

Methods: The Department of Defense Medical Metrics (M2) database was queried for the hospital admissions and billing data of a previously published cohort of soldiers injured in Iraq and Afghanistan between October 2001 and January 2005 and identified from the Joint Theater Trauma Registry. The US Army Physical Disability Administration database was also queried for Physical Evaluation Board outcomes for these soldiers, allowing calculation of disability benefit cost. Primary body region injured was assigned using billing records that gave a primary diagnosis International Classification of Diseases Ninth Edition code, which was corroborated with Joint Theater Trauma Registry injury mechanisms and descriptions for accuracy.

Results: A total of 1333 soldiers had complete admission data and were included from 1566 battle injuries not returned to duty of 3102 total casualties. Extremity-injured patients had the longest average inpatient stay at 10.7 days, accounting for 65% of the $65.3-million total inpatient resource utilization, 64% of the 464 patients found "unfit for duty," and 64% of the $170-million total projected disability benefit costs. Extrapolation of data yields total disability costs for this conflict, approaching $2 billion.

Conclusions: Combat-related extremity injuries require the greatest utilization of resources for inpatient treatment in the initial postinjury period, cause the greatest number of disabled soldiers, and have the greatest projected disability benefit costs. This study highlights the need for continued or increased funding and support for military orthopaedic surgeons and extremity trauma research efforts.

MeSH terms

  • Adult
  • Afghan Campaign 2001-*
  • Cohort Studies
  • Disability Evaluation*
  • Female
  • Health Care Costs / statistics & numerical data
  • Health Resources / statistics & numerical data*
  • Humans
  • Iraq War, 2003-2011*
  • Male
  • Middle Aged
  • Military Personnel / statistics & numerical data*
  • Outcome Assessment, Health Care / economics
  • Outcome Assessment, Health Care / statistics & numerical data*
  • Prevalence
  • United States
  • Warfare
  • Wounds and Injuries / economics*
  • Wounds and Injuries / epidemiology