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.
