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Hand And Upper Extremity Infections in Intravenous Drug Abusers: Predictors of Outcomes
Fernando Ovalle, MD; Anthony Thanh Vu, MD; Peter J. Stern, MD
University of Cincinnati, Cincinnati, OH
Introduction: Intravenous drug abuse (IVDA) is a national epidemic, public health problem, and troublesome cause of hand and upper extremity infections. This study characterizes the epidemiology of the IVDA patient population presenting to a midwestern urban emergency department (ED) and examines predictors influencing morbidity and outcomes.
Methods: A retrospective review was performed using ICD-9 codes to identify all adult patients, both with and without concurrent IVDA diagnoses, presenting to the ED with hand/upper extremity (UE) infections over 2.5 years. Demographic and clinical factors among the two groups were examined using univariate and multivariate analyses to identify predictors of outcomes, including not completing outpatient follow up and leaving against medical advice (AMA).
Results: A total of 1754 visits (1479 unique patients) were diagnosed with hand/UE infections, and 22.6% (396 visits, 308 unique) of those were due to IVDA. Heroin use was identified in 96% of visits. The mean age for the IVDA group was 35 ¬+ 10, 46% were male, and 91% were Caucasian. Psychiatric comorbidities and hepatitis C were common in the IVDA group (51% and 39%, respectively), and 31% of IVDA patients were uninsured. IVDA infections were more likely to have operating room intervention compared to non-IVDA patients (16% vs. 6%, respectively; P<0.0001), as well as longer mean length hospital stays (2.4 ¬+ 4.0 vs. 0.9¬ + 2.2 days, respectively; P<0.0001). IVDA patients were also more likely than non-IVDA patients to leave AMA (16% vs. 2%, P<0.0001) and to not complete outpatient follow-up (83% vs. 78%, P=0.04). In multivariate analysis, IVDA, psychiatric comorbidity and insurance status were independent predictors (P<0.05) for leaving AMA. IVDA and insurance status were also independent predictors of not completing follow-up.
Conclusion: In the setting of a national epidemic, hand and upper extremity infections due to IVDA are a troublesome yet increasingly common problem seen by hand surgeons. This study characterizes the growing IVDA patient population at an urban medical center and identifies risk factors for unfavorable outcomes that may be improved by targeted clinical counseling and social work interventions.
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