Does Illicit Drug Use Influence Inpatient Adverse Events, Death, Length of Stay and Discharge After Orthopaedic Trauma?

Abstract

Purpose: The prevalence of illicit drug use, such as opiates (including prescription opioids), cocaine, cannabis, in adults is increasing, but the risks of illicit drug use after orthopaedic trauma are not well studied. Our primary null hypothesis was that illicit drug use is not associated with inpatient adverse events after admission for musculoskeletal trauma. Secondary study questions addressed the association of illicit drug use with mortality, prolonged hospital stay, and nonroutine discharge. Methods: Using the Nationwide Inpatient Sample (NIS) database, we identified an estimated 7,118,720 orthopedic trauma inpatients from 2002-2011 and separated them into 2 groups: illicit drug users (1.5%) and non-illicit illicit drug users (98.5%). Multivariable regression modeling was used to determine the association between illicit drug use and the each of the outcome variables. Results: Illicit drug use was associated with higher odds of inpatient adverse events (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.6-1.7; P<0.001), lower likelihood of inpatient death (OR, 0.79; 95% CI, 0.72-0.88; P<0.001), prolonged hospital stay (OR, 1.4; 95% CI, 1.4-1.5; P<0.001) and higher odds of being discharged nonroutinely (OR, 1.3; 95% CI, 1.3-1.4; P<0.001). Conclusion: Our results indicate that illicit drug use was associated with increased likelihood of inpatient medical adverse events, prolonged hospital stay, and nonroutine discharge after orthopaedic trauma. Prompt recognition and proactive treatment measures for patients who have a history of illicit drug use may inform the management of orthopedic trauma inpatients.