Medical Student California Northstate University Elk Grove, California, United States
Introduction: Can methamphetamine positive patients safely undergo surgery, or should surgery be postponed until patients test negative? Our study aims to analyze the effects of active methamphetamine use on surgical complications and hospital disposition in the trauma setting, both in all trauma surgeries, as well as specifically neurosurgical trauma.
Methods: A retrospective chart review from 2015-2020 of all trauma patients undergoing surgery at a level-1 trauma center was performed. Patients were sorted by methamphetamine usage on initial exam into three categories: (1) METH- during screen, (2) METH+ during trauma screen, and (3) METH+ intraoperatively. A sub-group analysis was also performed on trauma patients undergoing neurosurgery: (1) METH- NSG patients and (2) METH+ NSG patients on screen, and (3) METH+ NSG intraoperatively. Patient variables included: age, sex, race, Injury Severity Score (ISS), ED Glasgow Coma Scale Score (GCS), complications , hospital and ICU length of stay and disposition. Categorical variables were analyzed using the x2-test, median values Wilcoxon Rank-sum test, and mean values two-sample t-test.
Results: Our study included 571 patient records, separated by pre-operative METH status. Of these 571, 150 were METH+ on their initial tox screen. Within that group, 118 were METH positive intra-operatively. Our analysis showed no significant differences between complication rates between METH- vs. METH+ screening or METH- vs. METH+ intra-operative groups. Comparisons between hospital LOS and ICU LOS also showed no significant differences between METH- vs. METH+ screening or METH- vs. intra-operative METH+ groups.
For neurosurgery, we analyzed 79 METH-, 18 METH+ and 10 METH+ intra-operative patients, and saw no significant differences in post-operative outcomes in either cohort.
Conclusion : We noted no significant differences in complication rate between METH+ patients and their METH- counterparts when looking at either general or neurosurgical trauma. Our study makes a strong push to eliminate the need to wait for methamphetamine washout prior to operating.
