# Healthcare Utilization Among United States Service Members with Combat-Related Lower Extremity Limb Salvage

## TL;DR

This study examines healthcare use among U.S. military members with combat-related lower limb injuries, finding that those with limb salvage followed by amputation used the most resources.

## Contribution

The study identifies distinct healthcare utilization patterns based on injury severity, particularly highlighting the high resource needs of the limb salvage with secondary amputation group.

## Key findings

- The LS-SA group had the highest mean total bed days and ICU days.
- Over 40% of the LS-SA group required four or more hospitalizations.
- Physical therapy had the highest clinic utilization among all groups.

## Abstract

Introduction: This study assessed healthcare utilization in the first year after combat-related lower extremity injuries in 4275 U.S. Service members. Varying injury severity was hypothesized to correlate with different utilization patterns, with the limb salvage with secondary amputation (LS-SA) group expected to have the highest resource use. Methods: Data on inpatient admissions and outpatient visits were analyzed across four injury groups: primary amputation (PA), LS-SA, limb salvage with no amputation (LS-NA), and non-threatened limb trauma (NTLT). The LS-SA group had the highest mean total bed days and intensive care unit (ICU) days, with over 40% requiring four or more hospitalizations. The sample averaged 208.9 outpatient visits. Physical therapy, orthopedics, and social work had the highest clinic engagement. Result: Initial engagement in therapy clinics was high for PA and LS-SA but decreased for LS-NA and NTLT after the first quarter, while primary care engagement was more consistent. Physical therapy had the highest mean clinic utilization. Most initial inpatient admissions were at Landstuhl Regional Medical Center. PA and LS-SA received the majority of outpatient care at three Advanced Rehabilitation Centers, while care was more distributed for LS-NA and NTLT. This study underscores the substantial healthcare burden of combat-related lower extremity injuries, with the LS-SA group exhibiting the greatest resource utilization. Conclusions: The findings emphasize the need to optimize extremity trauma care across the Military Healthcare System as Service members with these injuries require significant healthcare resources, necessitating optimization of both care delivery and the military healthcare system.