Outcomes of cocaine-positive trauma patients undergoing surgery on the first day after admission

Abstract

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 UCTĝ̂' 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 UCTĝ̂' 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 X 2 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 UCTĝ̂' 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. CONCLUSION:: 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. © 2008 by Lippincott Williams & Wilkins.