Outcomes of cocaine-positive trauma patients undergoing surgery on the first day after admission.
BACKGROUND
Concerns regarding complications of cocaine use are frequently used to justify delaying procedures among patients with positive urine cocaine toxicology (UCT); however, there is no evidence to support this practice. We investigated whether UCT+ patients experience a worse outcome than UCT- patients when undergoing surgery on the first day after admission to a trauma center.


METHODS
Files of adult trauma patients undergoing surgery during the first 24 hours after admission were selected from a trauma database. Patients without UCT testing were excluded. UCT+ and UCT- patients were compared in relation to mortality; length of stay; and the development of cardiac, infectious, and neurologic complications. Possible confounders were analyzed. Student's t test, Pearson's chi2 test, and Wilcoxon's statistics were used for analysis (alpha = 0.05). Multiple logistic regression models and Cox proportional hazard methods were used to adjust for possible confounders.


RESULTS
Of the 3,477 patients studied, 13% (n = 465) tested positive for cocaine. UCT+ patients had a different age distribution were more likely to be male and to have penetrating injury and had lower Injury Severity Scores than UCT- patients. Outcomes were similar for mortality (3% vs. 4%), for the development of infectious (18% and 19%) and neurologic (2% vs. 1%) complications, and median length of stay (5 days vs. 5 days). Cardiac complications were lower among the UCT+ patients (3% vs. 6%). Multiple logistic regression and Cox proportional hazard revealed results similar to those from the univariate analysis.


CONCLUSIONS
Outcomes after surgery during the first 24 hours after admission are not negatively affected by the presence of UCT+. An apparent protective effect of UCT+ status in the development of cardiac complications needs to be explained.
Program in Trauma, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA. gabyryb@pol.net
Gabriel E
GE
Ryb
Carnell
C
Cooper
D000328:Adult; D002423:Cause of Death; D003042:Cocaine / Q000652:urine*; D019970:Cocaine-Related Disorders / Q000175:diagnosis / Q000401:mortality* / Q000652:urine; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D008396:Maryland; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D012016:Reference Values; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000379:methods / Q000401:mortality*; D016019:Survival Analysis; D013997:Time Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery* / Q000652:urine
D003042:Cocaine