Outcomes of cocaine-positive trauma patients undergoing surgery on the first day after admission

J Trauma. 2008 Oct;65(4):809-12. doi: 10.1097/TA.0b013e318187803f.


Background: Concerns regarding complications of cocaine use are frequently used to justify delaying procedures among patients with positive urine cocaine toxicology (UCT); however, there is no evidence to support this practice. We investigated whether UCT+ patients experience a worse outcome than UCT- patients when undergoing surgery on the first day after admission to a trauma center.

Methods: Files of adult trauma patients undergoing surgery during the first 24 hours after admission were selected from a trauma database. Patients without UCT testing were excluded. UCT+ and UCT- patients were compared in relation to mortality; length of stay; and the development of cardiac, infectious, and neurologic complications. Possible confounders were analyzed. Student's t test, Pearson's chi2 test, and Wilcoxon's statistics were used for analysis (alpha = 0.05). Multiple logistic regression models and Cox proportional hazard methods were used to adjust for possible confounders.

Results: Of the 3,477 patients studied, 13% (n = 465) tested positive for cocaine. UCT+ patients had a different age distribution were more likely to be male and to have penetrating injury and had lower Injury Severity Scores than UCT- patients. Outcomes were similar for mortality (3% vs. 4%), for the development of infectious (18% and 19%) and neurologic (2% vs. 1%) complications, and median length of stay (5 days vs. 5 days). Cardiac complications were lower among the UCT+ patients (3% vs. 6%). Multiple logistic regression and Cox proportional hazard revealed results similar to those from the univariate analysis.

Conclusion: Outcomes after surgery during the first 24 hours after admission are not negatively affected by the presence of UCT+. An apparent protective effect of UCT+ status in the development of cardiac complications needs to be explained.

MeSH terms

  • Adult
  • Cause of Death*
  • Cocaine / urine*
  • Cocaine-Related Disorders / diagnosis
  • Cocaine-Related Disorders / mortality*
  • Cocaine-Related Disorders / urine
  • Cohort Studies
  • Female
  • Hospital Mortality / trends
  • Humans
  • Incidence
  • Injury Severity Score
  • Logistic Models
  • Male
  • Maryland
  • Middle Aged
  • Multivariate Analysis
  • Predictive Value of Tests
  • Probability
  • Prognosis
  • Proportional Hazards Models
  • Reference Values
  • Registries
  • Risk Assessment
  • Risk Factors
  • Surgical Procedures, Operative / methods
  • Surgical Procedures, Operative / mortality*
  • Survival Analysis
  • Time Factors
  • Trauma Centers
  • Wounds and Injuries / diagnosis
  • Wounds and Injuries / mortality*
  • Wounds and Injuries / surgery*
  • Wounds and Injuries / urine


  • Cocaine