Perioperative outcomes in patients with positive cocaine urine tests undergoing elective surgery: A systematic review

Cocaine use is a global concern, particularly in Europe, where it ranks as the second most commonly abused drug after cannabis. This systematic review examines perioperative outcomes in patients with positive cocaine urine tests scheduled for elective surgery.

We searched MEDLINE, Embase, Web of Science, Scopus, GlobalETD, and ClinicalTrials.gov. The study quality was assessed using the Newcastle-Ottawa Scale. Data were synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The systematic review protocol was registered with PROSPERO.

Three studies were analysed (n = 707 patients) (one retrospective cohort and two prospective cohort). No significant differences in haemodynamic event incidence were observed between positive and negative CUT groups. Two studies reported a higher use of vasopressors, and one study reported an increased use of antihypertensive administration in patients with a positive urine test for cocaine. No arrhythmias were reported. Mortality was assessed in two studies, neither of which reported any events. Two studies reported longer surgical durations in patients with a negative urine test for cocaine, without an associated increase in haemodynamic instability.

Asymptomatic patients with a positive cocaine urine test undergoing elective surgery have not been shown to have higher perioperative complication rates than controls. The limited number of studies and methodological shortcomings of the available evidence-such as retrospective design, small samples and potential biases-preclude definitive conclusions. Further prospective studies are needed to clarify perioperative risk and guide clinical decision-making.