Desai Rupak, Shamim Sofia, Patel Krupa, Sadolikar Ashish, Kaur Vikram Preet, Bhivandkar Siddhi, Patel Smit, Savani Sejal, Mansuri Zeeshan, Mahuwala Zabeen
Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, USA.
Family Medicine, Dekalb Medical Centre, Atlanta, USA.
Cureus. 2018 Aug 23;10(8):e3195. doi: 10.7759/cureus.3195.
Background Recent trends in the legalization of marijuana in many states are increasing the popularity of recreational marijuana use. Since current data on hospitalizations in marijuana users is sparse, we evaluated the primary reasons for admissions, procedures and associated healthcare burden in hospitalized recreational marijuana users. Methods The National Inpatient Sample (NIS) for the years 2010-2014 was queried for the hospitalizations with a history of recreational marijuana usage using applicable ICD-9 CM codes. Descriptive statistics were used to report frequency (N) and percentage (%). Discharge weights were applied to achieve national estimates. The predictors of in-hospital mortality in recreational marijuana users were assessed using a two-way hierarchical multivariate regression after adjusting for the confounders. Results We analyzed 465,959 (weighted n=2,317,343) hospitalizations with a history of recreational marijuana use. Among psychiatric disorders, most prominent primary discharge diagnoses were mood disorders (20.6%), schizophrenia/other psychotic disorders (10.6%), and substance/alcohol-related disorders (10.4%). Suicide and intentional self-inflicted injury (3.6%) was the leading cause of emergency admission. The most common non-psychiatric primary discharge diagnoses were diabetes mellitus with chronic complications (2.2%), acute myocardial infarction (AMI) (1.2%), nonspecific chest pain (1.1%), congestive cardiac failure (CHF) (1%), arrhythmia (0.8%), and hypertension (0.8%). Acute cerebrovascular diseases were noted in 1.1% and epilepsy in 1.8% of patients. Alcohol/drug rehabilitation and detoxification (6.9%) and psychiatric evaluation/therapy (3.9%) were the most evident psychiatric procedures whereas most frequent non-psychiatric procedures were diagnostic coronary arteriography (1%), percutaneous transluminal coronary angioplasty (0.7%), and echocardiogram (0.7%). Top independent predictors of in-hospital mortality were coagulopathy (OR 5.94), AMI (OR 4.59), pulmonary circulation disorder (OR 2.95), CHF (OR 2.02), renal failure (OR 1.91), coronary atherosclerosis (OR 1.34) and peripheral vascular disorder (OR 1.31). Major cardiovascular and cerebrovascular events also showed increasing trends among users. Conclusion We established the most frequent psychiatric and non-psychiatric causes of admissions and procedures in recreational marijuana users, which may pose a significant healthcare burden and increase the odds of in-hospital mortality.
背景 许多州大麻合法化的近期趋势正在增加娱乐性大麻使用的普及程度。由于目前关于大麻使用者住院情况的数据稀少，我们评估了住院娱乐性大麻使用者的入院主要原因、手术及相关医疗负担。方法 利用适用的国际疾病分类第九版临床修订本（ICD-9 CM）编码，查询2010 - 2014年国家住院患者样本（NIS）中具有娱乐性大麻使用史的住院病例。采用描述性统计报告频数（N）和百分比（%）。应用出院权重以获得全国估计值。在调整混杂因素后，使用双向分层多变量回归评估娱乐性大麻使用者院内死亡的预测因素。结果 我们分析了465,959例（加权n = 2,317,343）有娱乐性大麻使用史的住院病例。在精神疾病中，最突出的主要出院诊断是情绪障碍（20.6%）、精神分裂症/其他精神障碍（10.6%）以及物质/酒精相关障碍（10.4%）。自杀和故意自伤（3.6%）是急诊入院的主要原因。最常见的非精神科主要出院诊断是伴有慢性并发症的糖尿病（2.2%）、急性心肌梗死（AMI）（1.2%）、非特异性胸痛（1.1%）、充血性心力衰竭（CHF）（1%）、心律失常（0.8%）和高血压（0.8%）。1.1%的患者有急性脑血管疾病，1.8%的患者有癫痫。酒精/药物康复和解毒（6.9%）以及精神科评估/治疗（3.9%）是最常见的精神科手术，而最常见的非精神科手术是诊断性冠状动脉造影（1%）、经皮腔内冠状动脉成形术（0.7%）和超声心动图（0.7%）。院内死亡的主要独立预测因素是凝血病（比值比[OR] 5.94）、AMI（OR 4.59）、肺循环障碍（OR 2.95）、CHF（OR 2.02）、肾衰竭（OR 1.91）、冠状动脉粥样硬化（OR 1.34）和周围血管疾病（OR 1.31）。主要心血管和脑血管事件在使用者中也呈上升趋势。结论 我们确定了住院娱乐性大麻使用者入院和手术最常见的精神科和非精神科原因，这可能带来重大医疗负担并增加院内死亡几率。
