Outpatient prescription medications during the first year following combat-related amputations and traumatic brain injury: A retrospective study

Background: Prescription medications are an essential element of military amputation care programs. Objectives: To analyze (1) outpatient prescription medications following combat-related amputations, (2) longitudinal changes in prescription activity during the first year postinjury, and (3) patient characteristics associated with prescription medications. Design: Retrospective study of military casualty records and outpatient prescription medications. Clinicians identified 13 medication categories based on American Hospital Formulary Service classifications. Setting: Military amputation rehabilitation program. Patients: 1651 service members who sustained major limb amputations during 2001-2017. Main Outcomes Measures: Prescription medication category, days' supply, opioid dosage. Results: During the first year postinjury, patients averaged 65 outpatient prescriptions (new or refills, SD = 43.3) and 8 (SD = 1.9) of 13 medication categories. Nearly all patients (99%) had opioid prescriptions averaging high dosages with variation by patient characteristics and postinjury time. At least 84% of patients had prescriptions for one or more central nervous system, gastrointestinal, psychotherapeutic, immune/anti-infective and/or nonopioid analgesic medications. Prescriptions declined from the first (92%) to fourth (73%) quarter postinjury. Many patients had prescription opioids (51%), central nervous system medications (43%), or psychotherapeutic medications (32%) during the fourth quarter. In regression models, multiple factors including White race/ethnicity (relative risk [RR] = 1.16; 95% confidence interval [CI]: [1.06-1.28], p = .001), injury severity, traumatic brain injury, upper limb amputation (RR = 0.90; CI: [0.83-0.99], p = .020), multiple amputation (RR = 1.12 CI: [1.03-1.22], p = .008), phantom limb syndrome, chronic pain, and posttraumatic stress disorder were significantly associated with prescriptions (p's < .05). Conclusions: Amputation care providers manage a high volume and wide range of prescription medications including multiple central nervous system drugs. The results show significant variation in prescription practices by patient characteristics and time postinjury. These findings can help optimize the benefits and reduce the risks of prescription medications and indicate areas for future research.