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Published on: January 22, 2016
A burning issue: Methamphetamine intoxication is associated with graft loss
Parisa Oviedo1, Marjan Moghaddam2, John R Austin1
1UC San Diego, Division of Acute Care Surgery, 200 West Arbor Drive, #8896, San Diego, CA 92103, USA.
Introduction:
Methamphetamine intoxication can lead to medical complications in burn patients, including longer intensive care unit (ICU) stays, sepsis, and more burn debridement procedures. However, its impact on graft durability remains unexplored. We hypothesize that methamphetamine-positive burn patients have higher rates of graft loss.
Methods:
A single center retrospective cohort study of patients admitted to the burn service from 2021 to 2024 was performed at an American Burn Association (ABA)-verified burn center. Patients were age 18 years or over, had toxicology screening, and were excluded if not screened for methamphetamine. The primary outcome measured was graft loss requiring return to operating room for re-graft or flap repair. Patient demographics, burn etiology, and use of autograft, along with ICU days, ventilator days, and length of stay were recorded.
Results:
746 patients were included in this study with median age 48 years and median total burn surface area burned for the full cohort of 8.35%. 112 patients were methamphetamine-positive. Methamphetamine users had higher rates of autograft loss (p < 0.001), even on logistic regression analysis. Methamphetamine users had increased TBSA (p = 0.01), longer hospital stays (p = 0.03), and increased likelihood of undergoing endotracheal intubation (p = 0.01). Methamphetamine-positive patients presented primarily with flame burns (p < 0.001), while non-users presented primarily with scald burns (p < 0.001).
Conclusions:
Methamphetamine-positive burn patients were more likely to sustain flame burns, undergo autografting, and experience graft loss as a complication. Methamphetamine is a unique risk factor for burn patients that increases risk of failing graft management. Routine toxicology testing can promptly identify these patients and notify providers earlier to plan for more intensive burn management.
Insights
Methamphetamine-positive burn patients face higher graft loss rates, increasing the need for re-grafting. Early identification through toxicology screening is crucial for intensive burn management and improved outcomes.
Area of Science:
- Burn surgery
- Trauma surgery
- Toxicology
Background:
- Methamphetamine intoxication is linked to severe medical complications in burn patients, including extended intensive care unit (ICU) stays and increased sepsis rates.
- The impact of methamphetamine use on the durability and success of skin grafts in burn patients remains largely unknown.
- This study investigates the association between methamphetamine use and graft loss in adult burn patients.
Purpose of the Study:
- To determine if methamphetamine-positive burn patients experience higher rates of autograft loss compared to methamphetamine-negative patients.
- To identify potential risk factors and clinical outcomes associated with methamphetamine use in burn care.
- To inform clinical practice regarding the management of burn patients with a history of methamphetamine use.
Main Methods:
- A retrospective cohort study was conducted at a verified burn center, including adult patients admitted between 2021 and 2024.
- Patients aged 18 years and older with toxicology screening for methamphetamine were included; those without screening were excluded.
- The primary outcome was graft loss requiring re-operation, with data on demographics, burn etiology, graft type, ICU days, and length of stay collected.
Main Results:
- Out of 746 patients, 112 were methamphetamine-positive. Methamphetamine users showed significantly higher rates of autograft loss (p < 0.001).
- Methamphetamine-positive patients had larger total burn surface areas (TBSA) (p = 0.01), longer hospital stays (p = 0.03), and increased likelihood of intubation (p = 0.01).
- Flame burns were the primary etiology in methamphetamine users (p < 0.001), contrasting with scald burns in non-users (p < 0.001).
Conclusions:
- Methamphetamine use is a significant risk factor for graft loss in burn patients, necessitating specialized management.
- Patients testing positive for methamphetamine were more prone to flame burns and autograft failure.
- Routine toxicology screening can aid in early identification, allowing for proactive and intensive burn management strategies.
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