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Hand and Upper Extremity Infections in Intravenous Drug Abusers: Predictors of Outcomes
Fernando Ovalle MD, Anthony Vu MD, Laura Horodyski BA, Anas Minkara BS, Peter Stern MD
University of Cincinnati Medical Center
2016-02-01
Presenter: Fernando Ovalle, MD
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting and that this project represents the original work of the resident.
Director Name: W. John Kitzmiller
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Hand
Background: Intravenous drug abuse (IVDA) is a national epidemic and troublesome cause of hand and upper extremity infections. This study characterizes the epidemiology of the IVDA patient population presenting to an urban emergency department (ED) and examines predictors of outcomes.
Methods: A retrospective review was performed using ICD-9 codes to identify patients with IVDA and hand/upper extremity (UE) infection diagnoses in the ED over 2.5 years. Demographic and clinical factors were examined to identify predictors of outcomes, including not completing outpatient follow up, leaving against medical advice (AMA) and re-presentation to the ED with unresolved/recurrent infection.
Results: A total of 118 visits (74 unique patients) were diagnosed with both hand/UE infections and IVDA. The mean age was 37 +/- 10 and 40% were male. Psychiatric comorbidities were present in 47% of visits and and 27% were uninsured. Heroin use was identified in 93% of visits. Abscesses (68%) and cellulitis (29%) were the most common types of infections. 20% required operating room intervention. 17% of visits left AMA, 82% did not have follow up, and 18% re-presented to the ED. Younger age, female sex and lower severity of infection were predictors (P<0.05) for no follow up. Uninsured status (P=0.04) was predictive of leaving AMA. Psychiatric comorbidity (P=0.002) was predictive of re-presentation.
Conclusions: Hand and upper extremity infections due to IVDA are a troublesome yet common problem seen by hand surgeons. This study characterizes this patient population and identifies risk factors for unfavorable outcomes that may be targeted by clinical intervention.
