{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T15:02:03Z","timestamp":1781362923533,"version":"3.54.1"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"1-2","funder":[{"DOI":"10.13039\/100003896","name":"Henry M. Jackson Foundation","doi-asserted-by":"publisher","award":["HU00012020062"],"award-info":[{"award-number":["HU00012020062"]}],"id":[{"id":"10.13039\/100003896","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100003896","name":"Henry M. Jackson Foundation","doi-asserted-by":"publisher","award":["HU00012020062"],"award-info":[{"award-number":["HU00012020062"]}],"id":[{"id":"10.13039\/100003896","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,1,23]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Amputations at the hip and pelvic level are often performed secondary to high-energy trauma or pelvic neoplasms and are frequently associated with a prolonged postoperative rehabilitation course that involves a multitude of health care providers. The purpose of this study was to examine the health care utilization of patients with hip- and pelvic-level amputations that received care in the U.S. Military Health System.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We performed a retrospective review of all patients who underwent a hip- or pelvic-level amputation in the Military Health System between 2001 and 2017. We compiled and reviewed all inpatient and outpatient encounters during three time points: (1) 3\u2009months pre-amputation to 1 day pre-amputation, (2) the day of amputation through 12\u2009months post-amputation, and (3) 13-24\u2009months post-amputation. Health care utilization was defined as the average number of encounter days\/admissions for each patient. Concomitant diagnoses following amputation including post-traumatic stress disorder, traumatic brain injury, anxiety, depression, and chronic pain were also recorded.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 106 individuals with hip- and pelvic-level amputations were analyzed (69 unilateral hip disarticulation, 6 bilateral hip disarticulations, 27 unilateral hemipelvectomy, 2 bilateral hemipelvectomies, and 2 patients with a hemipelvectomy and contralateral hip disarticulation). Combat trauma contributed to 61.3% (n\u2009=\u200965) of all amputations. During the time period of 3 months pre-amputation, patients had an average of 3.8 encounter days. Following amputation, health care utilization increased in both the year following amputation and the time period of 13-24\u2009months post-amputation, averaging 170.8 and 77.4 encounter days, respectively. Patients with trauma-related amputations averaged more total encounter days compared to patients with disease-related amputations in the time period of 12\u2009months following amputation (203.8 vs.106.7, P\u2009&amp;lt;\u2009.001) and the time period of 13-24\u2009months post-amputation (92.0 vs. 49.0, P\u2009=\u2009.005). PTSD (P\u2009=\u2009.02) and traumatic brain injuries (P\u2009&amp;lt;\u2009.001) were more common following combat-related amputations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This study highlights the increased health care resource demand following hip- and pelvic-level amputations in a military population, particularly for those patients who sustained combat-related trauma. Additionally, patients with combat-related amputations had significantly higher rates of concomitant PTSD and traumatic brain injury. Understanding the extensive needs of this unique patient population helps inform providers and policymakers on the requirements for providing high-quality care to combat casualties.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usad295","type":"journal-article","created":{"date-parts":[[2023,7,29]],"date-time":"2023-07-29T13:06:33Z","timestamp":1690635993000},"page":"e235-e241","source":"Crossref","is-referenced-by-count":3,"title":["Healthcare Utilization Following Hemipelvectomy or Hip Disarticulation in\u00a0the Military Health System"],"prefix":"10.1093","volume":"189","author":[{"given":"Daniel","family":"Wido","sequence":"first","affiliation":[{"name":"Department of Rehabilitation, Walter Reed National Military Medical Center , Bethesda, MD 20814, USA"},{"name":"Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8871-4726","authenticated-orcid":false,"given":"Colin J","family":"Harrington","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Walter Reed National Military Medical Center , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca N","family":"Schulz","sequence":"additional","affiliation":[{"name":"The Center for Rehabilitation Sciences Research, Department of Physical Medicine & Rehabilitation, Uniformed Services University of Health Sciences , Bethesda, MD 20814, USA"},{"name":"The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD 20817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalyn C","family":"Jannace","sequence":"additional","affiliation":[{"name":"The Center for Rehabilitation Sciences Research, Department of Physical Medicine & Rehabilitation, Uniformed Services University of Health Sciences , Bethesda, MD 20814, USA"},{"name":"The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD 20817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas G","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Walter Reed National Military Medical Center , Bethesda, MD 20814, USA"},{"name":"Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"},{"name":"The Center for Rehabilitation Sciences Research, Department of Physical Medicine & Rehabilitation, Uniformed Services University of Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul F","family":"Pasquina","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation, Walter Reed National Military Medical Center , Bethesda, MD 20814, USA"},{"name":"Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"},{"name":"The Center for Rehabilitation Sciences Research, 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