June 12, 2017
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Drug abuse tied to worse outcomes after lower-extremity revascularization

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Among patients who underwent lower-extremity revascularization, those who abused drugs had increased risk for postoperative complications and elevated hospital costs, researchers reported.

In an abstract accepted for the Society for Vascular Surgery Vascular Annual Meeting, the researchers also wrote that drug abuse had no effect on mortality after lower-extremity revascularization.

Hanaa Dakour Aridi, MD, a postdoctoral research fellow working under the supervision of Mahmoud Malas, MD, FACS, at Johns Hopkins University School of Medicine, conducted a retrospective study of 209,838 patients in the Premier Healthcare Database who underwent endovascular or surgical lower-extremity revascularization from 2009 to 2015.

Hanaa Dakour Aridi, MD
Hanaa Dakour Aridi

“In Baltimore, we see the problem of drug abuse every day, which made us think: What are the outcomes of vascular procedures in drug abusers?” Aridi said in an interview with Cardiology Today’s Intervention. “We explored the outcomes after lower-extremity revascularization in patients with a history of drug abuse.”

Among the cohort, 0.7% were drug abusers, defined as abuse of opioids, sedatives, hypnotics, anxiolytics, cocaine, hallucinogens, antidepressants and amphetamines, and among those with drug abuse, the substance most often abused was opioids (59.1%).

Compared with nonabusers, drug abusers were younger (56.7 years vs. 67.8 years; P < .001), more likely to be men (66.8% vs. 57.6%; P < .001), single (58.8% vs. 42.4%; P .001), black (28.3% vs. 11.5%; P .001), to have chronic obstructive pulmonary disease (38.4% vs. 26.5%; P < .001), prior MI (33.4% vs. 22.3%; P < .001), congestive HF (25.7% vs. 17.2%; P < .001), renal disease (24.4% vs. 20.9%; P = .001), liver disease (9.3% vs. 1.4%; P < .001), critical limb ischemia (36.3% vs. 25%; P < .001), diabetes with complications (15.5% vs. 10%; P < .001) and HIV (1.2% vs. 0.1%; P < .001), Aridi and colleagues found.

Among those who underwent stenting, 0.6% were drug abusers, and those who abused drugs were more likely to experience in-hospital complications and to be discharged somewhere other than home (30% vs. 15.2%; P < .001). Median length of stay was 4 days (interquartile range [IQR], 2-8) in drug abusers and 1 day (IQR, 0-3) in nonabusers (P .001).

In the stenting cohort, total hospitalization costs were higher for drug abusers than nonabusers (adjusted mean difference, $1,443; P < .001), according to the researchers.

When Aridi and colleagues conducted a multivariate analysis, drug abuse was not associated with mortality, but was associated with increased risk for postoperative complications after stenting (OR = 1.43; 95% CI, 1.21-1.68) and bypass (OR = 1.37; 95% CI, 1.14-1.64) and increased likelihood of major amputation after stenting (OR = 2; 95% CI, 1.2-3.3).

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For a poster competition at the meeting, Aridi and colleagues presented data from 957 patients with drug abuse (mean age, 55 years; 73% men) and 55,478 patients without drug abuse (mean age, 66 years; 63% men) from the same database who underwent lower-extremity bypass between 2009 and 2015.

In unadjusted results, the drug abuse group had higher rates of secondary amputation (1.8% vs. 0.8%; P < .01); hemorrhage, bleeding or shock (21.3% vs. 18.5%; P = .03); stroke (1% vs. 0.56%; P = .05); pneumonia (3.2% vs. 1,9%; P < .01); respiratory failure (4.6% vs. 3.2%; P = .02); wound complication (2.7% vs. 1.7%; P = .02); and ileus (4.4% vs. 2.8%; P < .01). The drug abuse group had a longer length of stay (7 days vs. 5 days; P < .001) but a lower rate of mortality (0.7% vs. 1.6%; P = .03).

After coarsened exact matching of 499 patients from each group, there was no difference between the groups in mortality (nonabusers, 0.8%; abusers, 0.6%; P = 1), but abusers were at higher risk for any complication (32.9% vs. 24.9%; P = .01) and had higher total hospitalization costs ($19,963 vs. $16,496; P < .001).

“Abusers present with different physiology due to their drug abuse,” Aridi told Cardiology Today’s Intervention. “They have different comorbidities and risk factors compared with other vascular surgery patients. Drug abuse affects the vascular bed, whether due to the drug itself or the way it’s administered. When patients present for revascularization, many of them have arterial embolization, thrombosis or gangrene, which later on affects their management. Although mortality is not different between drug abusers and nonabusers, morbidity is higher in drug abusers ... which leads to prolonged hospital stay and increased resource utilization.

“There should be a standardized regimen for drug abusers admitted to the hospital, which will help in the initial treatment,” she said. “I believe resources invested in this population might reduce the cost of hospitalization and subsequent economic and health care costs.” – by Erik Swain

Reference:

Aridi HD, et al. Abstract PC146. Presented at: Society for Vascular Surgery Vascular Annual Meeting; May 31-June 3, 2017; San Diego.

Disclosure: Aridi reports no relevant financial disclosures.