U. Kannan2, M. M. John2, R. Gupta2, S. B. Remersu2, D. T. Farkas2 2Bronx- Lebanon Hospital Center,Surgery,Bronx, NY, USA
Introduction:
To review the outcomes following surgical procedures in patients testing positive for cocaine on preoperative urine toxicology screening
Methods:
The practice in our hospital is that patients with urine toxicology positive for cocaine are assessed clinically. If they are acutely toxic or they have a prolonged QTc interval on their electrocardiogram (EKG) the surgery is canceled unless it is an absolute emergency.The electronic medical records (EMR) were retrospectively reviewed for the years 2003-2014. Patients who underwent a surgical procedure whose urine toxicology screening was positive for cocaine were included. Only patients with a positive test on the same admission prior to the surgical procedure were included. Patients who did not receive general anesthesia were excluded. Patient demographics and the 30 day cardiovascular and neurological complications were collected and analyzed
Results:
There were 146 patients in total. After excluding the procedures without general anesthesia, there were 81 patients that were analyzed. There were 53 males and 28 females. The median age was 47 years (18-69 years). 21 procedures were elective and 60 were admitted through the emergency department. There were 54 general surgery cases, 8 orthopedic cases, 4 gynecologic, and 3 each of vascular, otolaryngology, dental, neurosurgical and urology cases.
Cardiovascular complications were noted in 4 patients (2 arrhythmias, non-ST elevated myocardial infarction (NSTEMI) and exacerbation of congestive heart failure) while neurological complications were seen in 2 patients (seizure and cerebrovascular accident). There was one mortality. The complications were reviewed and in most cases attributable to the illness and not cocaine (e.g. mortality after craniotomy for severe hemorrhagic stroke). The two arrhythmias (atrial fibrillation and supraventricular tachycardia) and the NSTEMI were the only ones possibly attributable to cocaine, and all three of these patients had other pre-existing cardiac comorbidities that could have contributed as well.
Conclusion:
A positive urine test for cocaine is not an absolute contraindication to surgery. In patients who are not acutely toxic and without a prolonged QTc interval, complications do not appear to significantly exceed that which would be expected in the population at large. The decision to proceed with surgery needs to be individualized to the patient and the indication for surgery.