Murray Erin P, Mansy Leilani, Lackey Joshua T, Link Robert C, Bonanni Sean, Sorensen Amelia A
Orthopaedic Surgery, University of Missouri - Kansas City, Kansas City, USA.
Cureus. 2021 Oct 27;13(10):e19082. doi: 10.7759/cureus.19082. eCollection 2021 Oct.
Background Methamphetamine use is increasing in prevalence. There is a theoretical increased risk of complication postoperative due to catecholamine depletion. When presented with an urgent surgical problem, there are little data to help counsel the patient on the risks of undergoing surgery in the setting of a positive methamphetamine test result. Aims and objectives The aim of this study was to examine the perioperative complication rate for patients who underwent emergent orthopaedic procedures in the setting of a positive methamphetamine drug screen. Additional data were collected in an attempt to further stratify risk factors for perioperative complications in this patient population. Design and methods A retrospective case series of 110 patients. Patients were identified by querying the medical record for patients with a positive methamphetamine result within 24 hours of the surgery start time. Data were collected on each patient, including the nature of the surgery, the type of injury sustained, disposition from the operating room, among other data points. The primary outcome was the presence of a perioperative cardiopulmonary complication, as determined by a new diagnosis made in the chart. The secondary outcome was whether the patient needed an increased level of care postoperatively. Results Of the 110 charts reviewed, three patients sustained complications during their hospitalization; an overall complication rate of 2.7%. One patient developed acute respiratory distress syndrome (ARDS), while two others developed surgical site infections. Of the 19 patients who went to the intensive care unit (ICU) postoperatively, none were because the patient required a higher level of care than the preoperative level. Conclusions Patients who underwent emergent surgical intervention in the setting of a positive methamphetamine drug test had a low complication rate. While the dogma is to delay surgery in the setting of methamphetamine use, the true risk of undergoing surgery in this setting is not fully understood. We advocate for continued research in this poorly studied group of patients. Larger studies will need to be done in order to fully understand the risks associated with operating in the setting of a positive methamphetamine drug screen.
甲基苯丙胺的使用在日益普遍。理论上，由于儿茶酚胺耗竭，术后并发症风险会增加。当面临紧急手术问题时，几乎没有数据可用于指导患者关于在甲基苯丙胺检测结果呈阳性的情况下接受手术的风险。目的：本研究的目的是检查甲基苯丙胺药物筛查呈阳性的情况下接受紧急骨科手术的患者的围手术期并发症发生率。还收集了其他数据，试图进一步对该患者群体围手术期并发症的危险因素进行分层。设计与方法：一项对110例患者的回顾性病例系列研究。通过查询手术开始时间24小时内甲基苯丙胺检测结果呈阳性的患者的病历记录来确定患者。收集了每位患者的数据，包括手术性质、所受损伤类型、手术室处置情况以及其他数据点。主要结局是围手术期心肺并发症的发生情况，由病历中新作出的诊断确定。次要结局是患者术后是否需要更高水平的护理。结果：在审查的110份病历中，3例患者在住院期间出现并发症；总体并发症发生率为2.7%。1例患者发生急性呼吸窘迫综合征（ARDS），另外2例发生手术部位感染。在术后进入重症监护病房（ICU）的19例患者中，没有一例是因为患者需要比术前更高水平的护理。结论：甲基苯丙胺药物检测呈阳性的情况下接受紧急手术干预的患者并发症发生率较低。虽然一般原则是在使用甲基苯丙胺的情况下推迟手术，但在这种情况下接受手术的真正风险尚未完全了解。我们主张对这一研究较少的患者群体继续进行研究。需要进行更大规模的研究，以便充分了解在甲基苯丙胺药物筛查呈阳性的情况下进行手术相关的风险。
