A Retrospective Description of Outpatient Medication Prescriptions Following Major Limb Amputation in the Iraq and Afghanistan conflicts: A Brief Report on the Population

Prescription medications play an essential role in military rehabilitation programs for patients who sustained combat-related amputations. The objectives are to describe: 1) outpatient medication prescriptions (including refills) among the population of U.S. Service members who sustained combat-related amputations, and 2) longitudinal changes in prescription activity during the first year postinjury. Methods. Clinicians retrospectively reviewed casualty records in the Expeditionary Medical Encounter Database. They identified 1,705 patients who sustained limb amputations in the Iraq and Afghanistan conflicts, 2001-2017. Of these 1705, we included 1,657 (97 percent) individuals with outpatient prescriptions during the first year postinjury recorded in the Department of Defense Pharmacy Data Transaction Service database. Clinicians identified 13 mutually exclusive and exhaustive medication categories (e.g., opioids, psychotherapeutic, immunologic) using the American Hospital Formulary Service Pharmacologic-Therapeutic Classification system. Results. During the first year postinjury, patients averaged 65 prescriptions (including refills) and 8 medication categories. Opioids had the highest prescription numbers (29 percent of all 107,507 prescriptions), percentage patients with a prescription (99 percent), and mean prescriptions (19). Along with opioids, the central nervous system (CNS), gastrointestinal/genitourinary, psychotherapeutic, immune/anti-infective, and nonopioid analgesic categories accounted for 85 percent of all prescriptions. Prescription activity declined from the first quarter (92 percent of patients) to the fourth quarter (73 percent) postinjury. Mean prescriptions and medication categories declined from the first quarter 29 prescriptions/6 categories) to the fourth quarter (12 prescriptions/3 categories).