Amphetamine Positivity Prior to Burn Surgery Does not Adversely Affect Intraoperative Outcomes.

Autor:	Rizk N; Department of Surgery, Stanford University School of Medicine, 770 Welch Road suite 400, Palo Alto, CA 94304, USA., Crawford D; UW Burn Center at Harborview Medical Center, University of Washington, 325 9th Ave Seattle, WA 98104, USA.; Department of Surgery, University of Washington, 325 9th Ave Seattle WA 98104, USA., Karanas Y; Regional Burn Center, Santa Clara Valley Medical Center, 751 S Bascom Ave San Jose, CA 95128, USA., Barnes C; UW Burn Center at Harborview Medical Center, University of Washington, 325 9th Ave Seattle, WA 98104, USA.; Department of Anesthesia, University of Washington, 325 9th Ave Seattle WA 98104, USA., Pham TN; UW Burn Center at Harborview Medical Center, University of Washington, 325 9th Ave Seattle, WA 98104, USA.; Department of Surgery, University of Washington, 325 9th Ave Seattle WA 98104, USA., Sheckter CC; Department of Surgery, Stanford University School of Medicine, 770 Welch Road suite 400, Palo Alto, CA 94304, USA.; Regional Burn Center, Santa Clara Valley Medical Center, 751 S Bascom Ave San Jose, CA 95128, USA.
Jazyk:	angličtina
Zdroj:	Journal of burn care & research : official publication of the American Burn Association [J Burn Care Res] 2024 Jan 05; Vol. 45 (1), pp. 17-24.
DOI:	10.1093/jbcr/irad165
Abstrakt:	The treatment of burn patients using amphetamines is challenging due hemodynamic liabilty and altered physiology. Wide variation exists in the operative timing for this patient population. We hypothesize that burn excision in patients admitted with amphetamine positivity is safe regardless of timing. Data from two verified burn centers between 2017 and 2022 with differing practice patterns in operative timing for amphetamine-positive patients. Center A obtains toxicology only on admission and proceeds with surgery based on hemodynamic status and operative urgency, whereas Center B sends daily toxicology until a negative test results. The primary outcome was the use of vasoactive agents during the index operation, modeled using logistic regression adjusting for burn severity and hospital days to index operation. Secondary outcomes included death and inpatient complications. A total of 270 patients were included, and there were no significant differences in demographics or burn characteristics between centers. Center A screened once and Center B obtained a median of four screens prior to the surgery. The adjusted OR of requiring vasoactive support intraoperatively was not associated with negative toxicology result (P = .821). Having a body surface area burned >20% conferred a significantly higher risk of vasoactive support (adj. OR 13.42 [3.90-46.23], P < .001). Mortality, number of operations, stroke, and hospital length of stay were similar between cohorts. Comparison between two verified burn centers indicates that waiting until a negative amphetamine toxicology result does not impact intraoperative management or subsequent burn outcomes. Serial toxicology tests are unnecessary to guide operative timing of burn patients with amphetamine use. (© The Author(s) 2023. Published by Oxford University Press on behalf of the American Burn Association. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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