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Kelly M, Huff T, Schabel K, Yoo J, Lieberman E, Kagan R. Active Amphetamine Abuse in Total Hip Arthroplasty Carries Increased Risk for Postoperative Surgical and Medical Complications. Arthroplast Today 2024; 27:101372. [PMID: 38654888 PMCID: PMC11035087 DOI: 10.1016/j.artd.2024.101372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 04/26/2024] Open
Abstract
Background The impact of amphetamine abuse on total hip arthroplasty (THA) outcomes has yet to be studied. As the rates of methamphetamine abuse continue to rise, understanding the risk profile of this population is imperative. This study aims to determine the risk of major surgical and medical complications for those with amphetamine abuse undergoing THA, with the hypothesis that amphetamine abuse carries increased risk. Methods A retrospective review was performed with all-claims data files of a large national database querying International Classification of Disease, tenth revision, procedure codes identifying 333,038 primary THA, and 1027 with active amphetamine abuse. Medical and surgical complications including infection, dislocation, implant failure, periprosthetic fracture, and revision, as well as length of hospital stay and 90-day readmission rate, were identified. Univariate analysis compared rates of dependent outcomes. To account for independent variables, logistic regression was performed using age, Charlson comorbidity index, sex, obesity, tobacco use, and alcohol use. The results were presented as odds ratios (OR) and P values with significance set at <0.05. Results Patients with active amphetamine abuse carried an increased risk of dislocation (OR 1.82, P ≤ .001), infection (OR 2.37, P ≤ .001), mechanical complications (OR 1.64, P ≤ .001), periprosthetic fracture (OR 1.53, P ≤ .05), revision (OR 1.70, P ≤ .001), 90-day readmission (OR 1.79, P ≤ .001), as well as medical complications (1.43, P = .02) compared to those without documented amphetamine abuse. Conclusions Patients with amphetamine abuse are at increased risk of postoperative surgical and medical complications following THA. We recommend consideration of these risks prior to primary THA in this patient population.
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Affiliation(s)
- Mackenzie Kelly
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Thomas Huff
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Kathryn Schabel
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | - Jung Yoo
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
| | | | - Ryland Kagan
- Department of Orthopaedics and Rehabilitation, Oregon Health & Science University, Portland, OR, USA
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Wei SY, Su CC, Hu HY, Lin SY, Pan CH. Shedding light on the hidden methamphetamine abuse: a nation-wide 7-year post-mortem study in Taiwan. J Epidemiol 2024:JE20230263. [PMID: 38462530 DOI: 10.2188/jea.je20230263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND The number of methamphetamine-related deaths has been increasing in recent decades. However, current data primarily rely on a few large-scale national surveys, highlighting the need for diverse data sources. Post-mortem studies offer advantages that compensate for the limitations of cohort studies. In this study, we aimed to (1) examine mortality rates and years of potential life lost, (2) compare proportionate mortality with previous cohort studies, and (3) quantitatively investigate causes of death as potential risk factors associated with each manner of death. METHODS We analyzed 740 cases from 2013 to 2019 in Taiwan. RESULTS The mean age of cases was 38.4 years, with a notable loss of 30s years of potential life, and 79.6% were male. The crude mortality rate was 0.45 per 100,000 person-years. The proportionate mortality indicated that autopsy dataset, compared to cohort studies, provided more accurate estimations for accidental deaths, equivalent suicides, underestimated natural deaths, and overestimated homicides. Accidental deaths were evident in 67% of cases with 80% attributed to drug intoxication. Multiple substances were detected in 61% of cases, with psychiatric medications detected in 43% of cases. Higher methamphetamine concentrations and a greater proportion of multiple substances and benzodiazepines were detected in suicidal deaths. Among accidental deaths, traffic accidents (7.9%) were the second most common cause, particularly motorcycle riders. CONCLUSIONS Using autopsy dataset as a secondary source, we identified that over half of the cases involved accidental drug intoxication. The significant proportion of cases involving multiple substances, psychiatric medications, and drug-impaired driving raises concerning.
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Affiliation(s)
- Shyh-Yuh Wei
- Department of Psychiatry, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Chien-Chou Su
- Clinical Innovation and Research Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University
| | - Hsuan-Yun Hu
- Institute of Forensic Medicine, Ministry of Justice
| | - Szu-Yu Lin
- Institute of Forensic Medicine, Ministry of Justice
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Stanton E, Karanas Y, Pham T, Gillenwater J, Sheckter CC. Inpatient Complications and Outcomes for Burn Patients Admitted with Methamphetamine Intoxication. J Burn Care Res 2024:irae014. [PMID: 38285638 DOI: 10.1093/jbcr/irae014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Indexed: 01/31/2024]
Abstract
Methamphetamine intoxication frequently complicates inpatient burn admissions. While single-institution studies describe adverse outcomes during resuscitation, little is known about the risks of amphetamine intoxication on inpatient complications and perioperative management. The US National Trauma Data Bank was queried for burn encounters between 2017-2021. Amphetamine intoxication was identified on admission. Primary outcomes included death, stroke, and myocardial infarction (MI). Secondary outcomes included organ failure and surgical management. Multivariable regressions modeled outcomes adjusting for available covariates including demographics, total body surface area (TBSA) burned, and inhalation injury. Bonferroni adjustments were applied. Our study identified a total of 73,968 primary burn encounters with toxicology screens. Among these, 800 cases (1.1%) were found to have positive methamphetamine drug screens upon admission. Methamphetamine users were significantly older (41.7 versus 34.9 years, p<.001), had a greater percentage of males (69.6 vs. 65.4, p=.045), were more likely to have inhalation injury (p<.001) and had larger %TBSA burns (16% vs. 13%, (p<.001). Methamphetamine users were no more likely to die, experience MI, or experience stroke during admission. In contrast, methamphetamine users were significantly more likely to have alcohol withdrawal (p=.019), AKI (p<.001), deep vein thrombosis (DVT) (p=.001) , pulmonary embolism (PE) (p=.039), sepsis (p=.026), and longer ICU stays (p<.001). Methamphetamine use was associated with a longer number of days to first procedure (p=.005). Of all patients who required surgery (15.0%), methamphetamine users required significantly more total debridements and reconstructive procedures (p<.001). While not associated with mortality, methamphetamine intoxication was associated with an increased risk of many complications including PE, DVT, AKI, sepsis, and longer ICU stays. Methamphetamine intoxication was associated with delays in surgical care.
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Affiliation(s)
- Eloise Stanton
- Division of Plastic and Reconstructive Surgery, University of Southern California, USA
| | - Yvonne Karanas
- Regional Burn Center, Santa Clara Valley Medical Center, USA
| | - Tam Pham
- UW Medicine Regional Burn Center, Harborview Medical Center, University of Washington, USA
| | - Justin Gillenwater
- Division of Plastic and Reconstructive Surgery, University of Southern California, USA
| | - Clifford C Sheckter
- Regional Burn Center, Santa Clara Valley Medical Center, USA
- Department of Surgery, Stanford University, USA
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Manja V, Sandhu ATS, Frayne S, Asch S, McGovern M, Chen C, Heidenreich P. Variation in Methamphetamine-Associated Heart Failure Hospitalizations Across the United States. J Card Fail 2024; 30:91-94. [PMID: 37611844 DOI: 10.1016/j.cardfail.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/26/2023] [Accepted: 07/31/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Veena Manja
- Veterans Affairs, Northern California Health Care System, Mather, CA, and University of California, Davis, Sacramento, CA.
| | | | - Susan Frayne
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, Stanford University
| | - Steven Asch
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, Stanford University
| | | | - Cheng Chen
- VA Palo Alto Health Care System, Palo Alto, CA, Stanford University
| | - Paul Heidenreich
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, Stanford University
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Zhou J, Wu A, Miao J, Singh H. Serum Methamphetamine Positivity in Trauma Patients Undergoing Surgery has No Negative Effect on Postoperative Morbidity and Mortality. J Emerg Trauma Shock 2023; 16:102-108. [PMID: 38025508 PMCID: PMC10661571 DOI: 10.4103/jets.jets_39_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/17/2023] [Accepted: 06/08/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction The link between methamphetamine (METH) use and mortality or morbidity, particularly perioperative complications, associated with trauma surgery are not well characterized. This study aims to address this by performing a comparison of surgical outcomes between METH-negative (METH-) and METH-positive (METH+) trauma patients. Methods An Institutional Review Board-approved retrospective chart review was performed on all trauma patients admitted to our Level 1 trauma center who underwent surgical operations between 2015 and 2020. Patients were categorized into METH- and METH+ groups. Patient characteristics such as age, sex, race, Injury Severity Score (ISS), presence of peri-operative complications, and mortality, amongst others, were used to perform univariate comparisons. Additional multi-variate comparisons were performed across both the whole cohort and with age, sex, and ISS-matched groups. Results Of 571 patients who met the final inclusion criteria, 421 were METH- and 150 METH+. The METH+ group also possessed a lower median ISS (P = 0.0478) and did not possess significantly different mortality or morbidity than their METH- counterparts in univariate analysis. Multivariate analysis in whole-group and matched-group cohorts indicated that METH was not a positive predictor of mortality or morbidity. Instead, ISS predicted mortality (P = 0.048) and morbidity (P < 0.001). Conclusion Our results suggest that METH use does not exert a positive effect on mortality or morbidity in the acute trauma surgery setting and that ISS may be a more significant contributor, suggesting severity, and etiology of injury are also important considerations for trauma surgery evaluation.
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Affiliation(s)
- James Zhou
- Department of Clinical Medicine, California Northstate University College of Medicine, Elk Grove, USA
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, USA
- Department of Neurosurgery, Santa Clara Valley Medical Center, San Jose, USA
| | - Adela Wu
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, USA
| | - Jingya Miao
- Department of Clinical Medicine, Western University College of Osteopathic Medicine, Pomona, CA, USA
| | - Harminder Singh
- Department of Neurosurgery, Stanford University School of Medicine, Palo Alto, USA
- Department of Neurosurgery, Santa Clara Valley Medical Center, San Jose, USA
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Choi NG, Choi BY, Marti CN, DiNitto DM, Baker SD. Substance use and medical outcomes in those age 50 and older involving cocaine and metamfetamine reported to United States poison centers. Clin Toxicol (Phila) 2023; 61:400-407. [PMID: 37083082 PMCID: PMC10339160 DOI: 10.1080/15563650.2023.2185494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/18/2023] [Accepted: 02/23/2023] [Indexed: 04/22/2023]
Abstract
CONTEXT Cocaine and metamfetamine use and overdose deaths among United States adults have been increasing in recent years. We examined associations of medical outcomes with co-used opioids and other substances among cocaine, and metamfetamine exposures in people age ≥50 years (N = 9300) reported to the National Poison Data System, 2015-2021. METHODS We first described increases in these exposures over time. We fitted generalized linear models for a Poisson distribution with a log link, one for cocaine exposures and the other for metamfetamine exposures, to examine associations of medical outcomes (major effects/death versus all others) with co-used other substances, controlling for exposure year and demographics. RESULTS The number of exposures increased steadily during the seven years, but metamfetamine exposures increased more rapidly starting in 2018. One-fifth of cocaine and one-sixth of metamfetamine exposures suffered major effects/death. Co-use of prescription opioids (incident risk ratio = 2.00, 95% CI = 1.76-2.28 for cocaine; incident risk ratio = 1.62, 95% CI = 1.27-2.07 for metamfetamine), illicit fentanyl (incident risk ratio =1.88, 95% CI = 1.08-3.27 for cocaine; incident risk ratio = 2.05, 95% CI = 1.04-4.06 for metamfetamine), heroin (incident risk ratio =1.62, 95% CI = 1.37-1.90 for cocaine), or amfetamine (incident risk ratio =1.73, 95% CI = 1.28-2.33 for cocaine) was associated with a higher likelihood of major effects/death. DISCUSSION Increases in the number of cocaine and metamfetamine exposures among older adults reported to poison centers are of concern, and so is the increased risk of major effects/death from polysubstance use, especially prescription and illicit opioids, among these illicit psychostimulant users. CONCLUSIONS Healthcare provider screening of individuals at risk of cocaine and/or metamfetamine use and psychoeducation about the dangers of these substance use are needed.
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Affiliation(s)
- Namkee G Choi
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Bryan Y Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine & Bayhealth Medical Center, Dover, DE, USA
| | - C Nathan Marti
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Diana M DiNitto
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
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Abstract
Illicit drug use/misuse among older adults is understudied, although current trends point to older adults being the fastest-growing segment in the United States and other developed countries. There is a need for further insight into drug use patterns in older adults, who face their own set of socioeconomic, medical, and psychiatric problems. We reviewed the literature for data related to use/misuse of heroin and stimulants (cocaine, amphetamines, and methamphetamines) among people over the age of 40 years. We focused on prevalence rates of use/misuse of these substances, comorbidities, diagnostic challenges, screening tools, and treatment recommendations specific to the geriatric population.
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