骨科创伤伴物质使用障碍患者的随访及并发症发生率

IF 2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured Pub Date : 2025-08-28 DOI:10.1016/j.injury.2025.112730

Paul Toogood

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引用次数: 0

摘要

物质使用障碍（SUD）很常见，并与创伤有关[1-5]。尽管出现创伤性猝死的患者频率很高，而且在照顾这些患者的医护人员中，普遍存在对依从性、随访和并发症的担忧，但很少有人试图量化这类日常患者的结果。因此，本研究的目的是记录以物质使用障碍为表现的骨科创伤患者的基本人口统计学、随访率和手术结果。方法对观察性队列进行回顾性分析。2019年11月至2024年12月期间，所有年龄在70岁以下的骨骼成熟患者，以及允许在城市一级创伤中心由单一作者进行长期随访和骨科创伤手术治疗的保险，均被纳入研究对象。202例患者没有既往存在物质使用障碍（NO-SUD）， 96例患者存在（SUD）。比较术后第一年的基本人口统计信息、损伤特征、随访率和手术并发症发生率。结果SUD组和NO-SUD组的平均年龄和男性/女性比例无差异。在SUD队列中，白人较多，亚洲/太平洋岛民较少。在10种最常见的合并症中，只有在SUD队列中充血性心力衰竭（CHF）的发生率明显较高。损伤部位在队列之间没有差异。而在SUD队列中，更多的是发生高度开放性骨折。两组的随访率都很低，但在所有时间点上，SUD组的随访率都更低。SUD队列的住院时间也明显更长，1年时的死亡率也更高。感染、构造失败和截肢率在SUD队列中均较高。结论SUD与NO-SUD人群的人口统计学特征相似。损伤严重程度、随访率和并发症发生率在SUD队列中都明显更差。这些数据可用于外科医生对患者的预后和讨论手术干预对SUD人群的风险和益处。证据水平ii。

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Follow-up and complications rates in orthopedic trauma patients with substance use disorders

Background

Substance use disorders (SUD) are common and associated with trauma [1–5]. Despite the high frequency of patients with SUDs presenting with trauma and the ubiquitous concerns about compliance, follow-up, and complications amongst providers caring for these patients there has been little attempt to quantify outcomes in this everyday group of patients. The purpose of the current study was thus to document basic demographics, follow-up rates, and surgical outcomes in orthopedic trauma patients presenting with substance use disorders.

Methods

A retrospective review of an observational cohort was performed. All skeletally mature patients younger than 70 and with insurance that allowed long term follow-up and surgically treated for orthopedic trauma by a single author at an urban level-1 trauma center between November 2019 and December 2024 were enrolled. 202 patients did not have a pre-existing substance use disorder (NO-SUD), 96 patients did (SUD). Basic demographic information, injury characteristics, follow-up rates, and surgical complication rates over the first post-operative year were compared.

Results

Mean age and percentage of male/female did not differ between SUD and NO-SUD cohorts. There were more white and fewer Asian/Pacific Islanders in the SUD cohort. Of the 10 most common comorbidities, there was only a significantly higher rate of congestive heart failure (CHF) in the SUD cohort. Injury location did not differ between cohorts. Those in the SUD cohort more often had high grade open fractures. Follow-up rates in both groups were poor, but worse at all time points for those in the SUD cohort. The SUD cohort also had significantly longer lengths of stay and a higher mortality rate at 1 year. Infection, construct failure, and amputations rates were all higher in the SUD cohort.

Conclusions

Demographics between the SUD and NO-SUD populations were similar. Injury severity, follow-up rates, and complication rates were all significantly worse in the SUD cohort. Such data can be used by surgeons to council patients on prognosis and when discussing the risks and benefits of surgical intervention in the SUD population.

Level of evidence

III.

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来源期刊

Injury-International Journal of the Care of the Injured 医学-急救医学

CiteScore

4.00

自引率

8.00%

发文量

699

审稿时长

96 days

期刊介绍： Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.