A. Vrana2, C. Smitterberg2, D. Halalmeh1, J. Cranford1,3, R. Reece3, N. Aftab1, G. Sachwani-Daswani1 1Hurley Medical Center, Department Of Trauma And Acute Care Surgery, Flint, MI, USA 2Michigan State University, College Of Human Medicine, Lansing, MI, USA 3University Of Michigan, Department Of Emergency Medicine, Ann Arbor, MI, USA
Introduction:
Substance Use Disorder (SUD) is common among patients admitted to the hospital, with particularly high rates among those hospitalized for trauma. It is important to further our understanding on the clinical outcomes of trauma patients with SUD, a key metric for which is hospital length of stay (LOS). Increased LOS is associated with increased risk of adverse health events, such as drug reactions, nosocomial infection, and the development of decubitus ulcers. Beyond physical effects, increased LOS also presents psychosocial effects such as increased financial burden on patients and strain on social supports. There is little existing evidence on the relationship between SUD and LOS in trauma patients. In this study, we aim to investigate the impact of pre-existing SUD on hospital LOS in admitted trauma patients.
Methods:
We performed a retrospective analysis on all trauma patients admitted to our Level I Trauma Center between January 2021 and August 2023. Patients were categorized into two major groups: those with and without a history of SUD based on diagnoses in their electronic health record. Descriptive and regression analyses were performed to estimate the effect of SUD on hospital LOS and secondary endpoints such as ICU days and Injury Severity Score (ISS).
Results:
The study comprised 2,994 trauma patients aged 18 or older. Patients were categorized into those with documented SUD and those without, with 37.9% having a documented SUD. Patients with SUD were younger (mean age 40.88 vs. 58.99 years, p<.001) and predominantly male (72.9% vs. 53.3%, p<.001). SUD patients had higher rates of alcohol use disorder, bipolar disorder, and smoking, whereas non-SUD patients had higher rates of diabetes mellitus and hypertension. ISS was significantly higher in the SUD group, with more severe injuries (p=.04). Positive toxicology screens were more frequent in the SUD group. There was no significant difference in mean LOS (p=.51) and mean ICU days (p=.95) between the two groups. Discharge dispositions varied significantly, with more SUD patients discharged home. On multivariable regression analysis, Age and ISS (moderate and severe) were significant predictors of LOS, and SUD's impact on LOS approached significance (B=0.516, p=.056).
Conclusion:
Our study contributes to the growing body of literature examining the relationship between SUD and trauma care outcomes. While SUD does not appear to have a straightforward relationship with LOS in trauma patients, its presence is associated with a constellation of factors that complicate patient management. Addressing these factors through a multidisciplinary approach could improve patient outcomes and reduce LOS. By enhancing our understanding of how SUD interacts with other health variables in trauma patients, we can develop more effective strategies to optimize care for this vulnerable population.