title: A comparative analysis of the patient characteristics and cost of managing intravenous drug users (IVDU) with soft tissue abscesses with non-IVDU.
abstract: BACKGROUND
  Intravenous drug users (IVDU) often present to hospitals with complex co-morbidities, associated with prolonged in-patient admissions. The aim of this study was to compare a cohort of IVDU patients with soft tissue abscesses with non-IVDUs. We analysed the demographics, comorbidities, location of abscesses, multidisciplinary input and financial costs of managing both groups.
  
  
  METHODS
  A retrospective cohort study was conducted between January 2010 and September 2013. Two age and sex matched cohorts were compared: IVDU and non-IVDU.
  
  
  RESULTS
  We identified 44 IVDU patients and 54 non-IVDU patients. The IVDU had higher rates of smoking (89% p < 0.001) and unemployment (73% p < 0.05). The most common comorbidities in the IVDU cohort were hepatitis C (17%) and HIV (14%), whereas diabetes mellitus (15%) and hypertension (11%) were the most common in the non-IVDUs (p < 0.01). The most common location for an abscess in non-IVDU patients was the hand, whereas IVDU patients had abscesses in their groin. Groin injecting led to a referral to multiple specialties. The median length of stay for the IVDU patients was 4 days and for non-IVDU patients 1 day (p < 0.01). The average cost of managing IVDU patients in our unit was £1280: for non- IVDU the cost was £530 (p < 0.001).
  
  
  CONCLUSIONS
  IVDU patients with soft tissue abscesses have higher rates of smoking, unemployment, infection with hepatitis C and HIV compared to a control group. We have suggested several recommendations to optimise the management of these patients including the implementation of an additional code to compensate for the complexity of their management.
authors.affiliation: The Department of Trauma & Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, UK. Electronic address: neil.chotai@hotmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Chotai
authors.affiliation: The Department of Trauma & Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, UK.
authors.forename: K
authors.initials: K
authors.lastname: Gallagher
authors.affiliation: The Department of Trauma & Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, UK.
authors.forename: W K M
authors.initials: WK
authors.lastname: Kieffer
authors.affiliation: The Department of Trauma & Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, UK.
authors.forename: B A
authors.initials: BA
authors.lastname: Rogers
authors.affiliation: The Department of Trauma & Orthopaedics, Brighton and Sussex University Hospitals NHS Trust, Eastern Road, Brighton, BN2 5BE, UK.
authors.forename: D M
authors.initials: DM
authors.lastname: Ricketts
mesh_terms: D000038:Abscess / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D000293:Adolescent; D000328:Adult; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D006801:Humans; D015994:Incidence; D008297:Male; D012189:Retrospective Studies; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
keywords: Coding; Infection; Intravenous drug users; Management