Culhane John T, Freeman Carl A
Department of Surgery, Saint Louis University, Saint Louis, Missouri, USA.
Department of Trauma, Saint Louis University, Saint Louis, Missouri, USA.
J Emerg Trauma Shock. 2020 Oct-Dec;13(4):279-285. doi: 10.4103/JETS.JETS_141_19. Epub 2020 Dec 7.
Illegal drug use and need for surgery are common in trauma. This allows examination of the effects of perioperative drug use.
The aim was to study the effects of illegal drug use on perioperative complications in trauma.
Propensity-matched analysis of perioperative complications between drug screen-positive (DSP) and drug screen-negative (DSN) patients from the National Trauma Data Bank (NTDB).
The NTDB reports drug screening as a composite. We compared complications for DSP, DSN, and specific chronic drug disorders. Time to first procedure was analyzed to determine whether delay to surgery was associated with reduced complications.
Logistic regression with 11 predictor variables was used to calculate propensity scores. Categorical and continuous variables were compared using Chi-square and Student's -test, respectively.
752,343 patients (21.9%) were tested for illegal drugs. DSP was protective for mortality-relative risk (RR) 0.84 ( < 0.001) and arrhythmia RR 0.87 ( = 0.02). All complications (AC) were higher for DSP with a RR of 1.08 ( < 0.001). Cocaine, cannabis, and opioids were associated with reduced mortality. Cocaine was associated with increased myocardial infarction (MI). All four chronic drug disorders were associated with markedly higher arrhythmia. All except cannabis were associated with higher AC. Mortality was significantly lower for DSP for every time interval until first procedure. Continuous-time until procedure was associated with increased MI and arrhythmia.
DSP was protective of mortality and cardiac complications. Drug disorders were protective for mortality but increased arrhythmia and AC. Delay until the surgery does not diminish cardiac or overall risk.
创伤患者中非法药物使用和手术需求很常见。这使得可以研究围手术期药物使用的影响。
旨在研究非法药物使用对创伤患者围手术期并发症的影响。
对国家创伤数据库（NTDB）中药物筛查阳性（DSP）和药物筛查阴性（DSN）患者的围手术期并发症进行倾向匹配分析。
NTDB将药物筛查报告为一个综合指标。我们比较了DSP、DSN以及特定慢性药物紊乱患者的并发症情况。分析首次手术时间以确定手术延迟是否与并发症减少相关。
使用具有11个预测变量的逻辑回归来计算倾向得分。分类变量和连续变量分别使用卡方检验和学生t检验进行比较。
752343例患者（21.9%）接受了非法药物检测。DSP对死亡率具有保护作用，相对风险（RR）为0.84（P<0.001），对心律失常的RR为0.87（P = 0.02）。DSP的所有并发症（AC）更高，RR为1.08（P<0.001）。可卡因、大麻和阿片类药物与死亡率降低相关。可卡因与心肌梗死（MI）增加相关。所有四种慢性药物紊乱均与明显更高的心律失常相关。除大麻外，所有药物均与更高的AC相关。直到首次手术的每个时间间隔内，DSP的死亡率均显著较低。直到手术的连续时间与MI和心律失常增加相关。
DSP对死亡率和心脏并发症具有保护作用。药物紊乱对死亡率具有保护作用，但会增加心律失常和AC。延迟手术并不会降低心脏或总体风险。
