Healthcare Utilization Following Hemipelvectomy or Hip Disarticulation in the Military Health System

Area of Science:

• Orthopedic Surgery
• Trauma Surgery
• Rehabilitation Medicine

Background:

• Hip and pelvic amputations are complex procedures often necessitated by high-energy trauma or pelvic neoplasms.
• These amputations typically involve extensive postoperative rehabilitation requiring multidisciplinary healthcare provider involvement.

Purpose of the Study:

• To examine the healthcare utilization patterns of patients undergoing hip- and pelvic-level amputations within the U.S. Military Health System.
• To identify factors influencing healthcare resource demand in this patient population.

Main Methods:

• Retrospective review of patients undergoing hip- or pelvic-level amputations between 2001 and 2017 in the Military Health System.
• Analysis of inpatient and outpatient encounters during three distinct periods: pre-amputation, 0-12 months post-amputation, and 13-24 months post-amputation.
• Recording of concomitant diagnoses, including PTSD, TBI, anxiety, depression, and chronic pain.

Main Results:

• A total of 106 patients were analyzed, with 61.3% of amputations resulting from combat trauma.
• Healthcare utilization, measured in encounter days, significantly increased post-amputation, averaging 170.8 days in the first year and 77.4 days in the second year.
• Trauma-related amputations showed higher healthcare utilization (203.8 vs. 106.7 encounter days at 1 year) and a greater incidence of PTSD and TBI compared to disease-related amputations.

Conclusions:

• Hip and pelvic amputations, particularly those from combat trauma, impose a substantial demand on healthcare resources.
• Combat-related amputations are associated with significantly higher rates of co-occurring PTSD and TBI.
• Understanding these extensive needs is crucial for optimizing care delivery and resource allocation for military casualties.