Healthcare Utilization Following Major Limb Loss in Adults (18-64) Receiving Care in the Military Health System from 2001 to 2017

Rebecca N Schulz; Kalyn C Jannace; Daniel B Cooper; Tawnee L Sparling; Michelle L Luken; Paul F Pasquina

doi:10.1016/j.apmr.2023.08.013

Healthcare Utilization Following Major Limb Loss in Adults (18-64) Receiving Care in the Military Health System from 2001 to 2017

Arch Phys Med Rehabil. 2023 Sep 16;S0003-9993(23)00480-X. doi: 10.1016/j.apmr.2023.08.013. Online ahead of print.

Authors

Rebecca N Schulz¹, Kalyn C Jannace², Daniel B Cooper², Tawnee L Sparling³, Michelle L Luken², Paul F Pasquina³

Affiliations

¹ Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of Health Sciences, Bethesda, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD. Electronic address: rebecca.schulz.ctr@usuhs.edu.
² Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of Health Sciences, Bethesda, MD; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD.
³ Walter Reed National Military Medical Center, Bethesda, MD; Uniformed Services University of Health Sciences, Bethesda, MD.

PMID: 37722649
DOI: 10.1016/j.apmr.2023.08.013

Abstract

Objective: To characterize and quantify healthcare utilization of Military Health System beneficiaries with major limb loss.

Design: Retrospective cohort study.

Setting: Military treatment facilities and civilian healthcare facilities that accept TRICARE insurance across the United States.

Participants: A total 5,950 adult Military Health System beneficiaries with major limb amputation(s) acquired between January 1^st, 2001 and September 30^th, 2017.

Interventions: Not applicable.

Main outcome measure(s): This study was an exploratory analysis designed to identify common care specialties, services, and devices utilized by Military Health System beneficiaries with major limb loss.

Results: Most beneficiaries were retirees/dependents (63.3%), male (73.1%), and had a single amputation (88.7%), with a mean age of 42 years. Differences between beneficiary categories were found. Active-duty service members utilized a larger proportion of inpatient, emergency, primary care, physical and occupational therapy, prosthetics and orthotics, physical medicine and rehabilitation, and psychiatry services than retirees/dependents. Most common procedures included "revision of amputation stump" (57.2%) for the active-duty population and "other amputation below knee" (24.3%) for the retirees/dependents.

Conclusions: These findings highlight the rehabilitation trajectories of beneficiaries receiving treatment for major limb loss in military and civilian care settings. The results could inform staffing decisions and training programs for military treatment facilities, American trauma centers, rehabilitation hospitals, and outpatient healthcare providers treating individuals with amputation.

Keywords: Amputation, Surgical; Amputation, Traumatic; Facilities and Services Utilization; Military Health Services; Rehabilitation.