Opioid-related compartment syndrome and associated morbidity

Sandesh S. Rao, J. Gregory Mawn, Gilberto O. Lobaton, V. Puvanesarajah, R. M. Amin, Casey Humbyrd, Robert Steven Sterling

Research output: Contribution to journalArticle

Abstract

Introduction: Opioid-related compartment syndrome (ORCS) is an understudied complication related to opioid overdose. We hypothesized that ORCS would be associated with worse clinical outcomes, including higher amputation rates, need for multiple surgical procedures, and rhabdomyolysis on admission, compared with nonopioid-related compartment syndrome (NORCS). Methods: We used Current Procedural Terminology codes for fasciotomy as a proxy marker for cases of compartment syndrome treated at 1 health system from January 1, 2016, to December 21, 2018. We excluded patients younger than 18 years, those treated for exertional compartment syndrome, and those who underwent elective fasciotomies. Seventy-four patients met our inclusion criteria. Data reviewed included patient characteristics, cause of compartment syndrome, time until evaluation for compartment syndrome, peak creatinine kinase levels, number of surgical procedures required, duration of hospital stay, and postoperative inpatient morbidity and death. Patients were categorized as having ORCS (n = 8) or NORCS (n = 66). Alpha = .05. Results: All cases of ORCS occurred in men. Opioid use was the third most common cause of compartment syndrome. Two patients underwent amputation, both in the ORCS group (p < 0.01). The median number of debridements was significantly higher for the ORCS group (median, 4; interquartile range [IQR]: 3–6) than for the NORCS group (median, 3; IQR 2–4) (p = 0.03). Duration of hospital stay was longer for the ORCS group (median, 27 days; IQR 16–38) compared with the NORCS group (median, 9 days; IQR: 5–13) (p < 0.001). Mean (± standard deviation) peak creatinine kinase level was significantly higher in the ORCS group (224,000 ± 225,052 U/L) compared with the NORCS group (7550 ± 32,500) (p < 0.001). The proportion of patients who underwent hemodialysis was higher in the ORCS group (88%) than in the NORCS group (35%) (p < 0.001). All ORCS patients presented >8 h after immobilization in a dependent position. Conclusion: Patients in the ORCS group had delayed presentations and significantly more morbidity compared with patients in the NORCS group.

Original languageEnglish (US)
JournalInjury
DOIs
StatePublished - Jan 1 2019

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Compartment Syndromes
Opioid Analgesics
Morbidity
Amputation
Current Procedural Terminology
Rhabdomyolysis
Proxy
Immobilization

Keywords

  • Amputation
  • Compartment syndrome
  • Fasciotomy
  • Hemodialysis
  • Morbidity
  • Opioid-related compartment syndrome
  • Opioids

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

Opioid-related compartment syndrome and associated morbidity. / Rao, Sandesh S.; Mawn, J. Gregory; Lobaton, Gilberto O.; Puvanesarajah, V.; Amin, R. M.; Humbyrd, Casey; Sterling, Robert Steven.

In: Injury, 01.01.2019.

Research output: Contribution to journalArticle

Rao, Sandesh S. ; Mawn, J. Gregory ; Lobaton, Gilberto O. ; Puvanesarajah, V. ; Amin, R. M. ; Humbyrd, Casey ; Sterling, Robert Steven. / Opioid-related compartment syndrome and associated morbidity. In: Injury. 2019.
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abstract = "Introduction: Opioid-related compartment syndrome (ORCS) is an understudied complication related to opioid overdose. We hypothesized that ORCS would be associated with worse clinical outcomes, including higher amputation rates, need for multiple surgical procedures, and rhabdomyolysis on admission, compared with nonopioid-related compartment syndrome (NORCS). Methods: We used Current Procedural Terminology codes for fasciotomy as a proxy marker for cases of compartment syndrome treated at 1 health system from January 1, 2016, to December 21, 2018. We excluded patients younger than 18 years, those treated for exertional compartment syndrome, and those who underwent elective fasciotomies. Seventy-four patients met our inclusion criteria. Data reviewed included patient characteristics, cause of compartment syndrome, time until evaluation for compartment syndrome, peak creatinine kinase levels, number of surgical procedures required, duration of hospital stay, and postoperative inpatient morbidity and death. Patients were categorized as having ORCS (n = 8) or NORCS (n = 66). Alpha = .05. Results: All cases of ORCS occurred in men. Opioid use was the third most common cause of compartment syndrome. Two patients underwent amputation, both in the ORCS group (p < 0.01). The median number of debridements was significantly higher for the ORCS group (median, 4; interquartile range [IQR]: 3–6) than for the NORCS group (median, 3; IQR 2–4) (p = 0.03). Duration of hospital stay was longer for the ORCS group (median, 27 days; IQR 16–38) compared with the NORCS group (median, 9 days; IQR: 5–13) (p < 0.001). Mean (± standard deviation) peak creatinine kinase level was significantly higher in the ORCS group (224,000 ± 225,052 U/L) compared with the NORCS group (7550 ± 32,500) (p < 0.001). The proportion of patients who underwent hemodialysis was higher in the ORCS group (88{\%}) than in the NORCS group (35{\%}) (p < 0.001). All ORCS patients presented >8 h after immobilization in a dependent position. Conclusion: Patients in the ORCS group had delayed presentations and significantly more morbidity compared with patients in the NORCS group.",
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T1 - Opioid-related compartment syndrome and associated morbidity

AU - Rao, Sandesh S.

AU - Mawn, J. Gregory

AU - Lobaton, Gilberto O.

AU - Puvanesarajah, V.

AU - Amin, R. M.

AU - Humbyrd, Casey

AU - Sterling, Robert Steven

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Introduction: Opioid-related compartment syndrome (ORCS) is an understudied complication related to opioid overdose. We hypothesized that ORCS would be associated with worse clinical outcomes, including higher amputation rates, need for multiple surgical procedures, and rhabdomyolysis on admission, compared with nonopioid-related compartment syndrome (NORCS). Methods: We used Current Procedural Terminology codes for fasciotomy as a proxy marker for cases of compartment syndrome treated at 1 health system from January 1, 2016, to December 21, 2018. We excluded patients younger than 18 years, those treated for exertional compartment syndrome, and those who underwent elective fasciotomies. Seventy-four patients met our inclusion criteria. Data reviewed included patient characteristics, cause of compartment syndrome, time until evaluation for compartment syndrome, peak creatinine kinase levels, number of surgical procedures required, duration of hospital stay, and postoperative inpatient morbidity and death. Patients were categorized as having ORCS (n = 8) or NORCS (n = 66). Alpha = .05. Results: All cases of ORCS occurred in men. Opioid use was the third most common cause of compartment syndrome. Two patients underwent amputation, both in the ORCS group (p < 0.01). The median number of debridements was significantly higher for the ORCS group (median, 4; interquartile range [IQR]: 3–6) than for the NORCS group (median, 3; IQR 2–4) (p = 0.03). Duration of hospital stay was longer for the ORCS group (median, 27 days; IQR 16–38) compared with the NORCS group (median, 9 days; IQR: 5–13) (p < 0.001). Mean (± standard deviation) peak creatinine kinase level was significantly higher in the ORCS group (224,000 ± 225,052 U/L) compared with the NORCS group (7550 ± 32,500) (p < 0.001). The proportion of patients who underwent hemodialysis was higher in the ORCS group (88%) than in the NORCS group (35%) (p < 0.001). All ORCS patients presented >8 h after immobilization in a dependent position. Conclusion: Patients in the ORCS group had delayed presentations and significantly more morbidity compared with patients in the NORCS group.

AB - Introduction: Opioid-related compartment syndrome (ORCS) is an understudied complication related to opioid overdose. We hypothesized that ORCS would be associated with worse clinical outcomes, including higher amputation rates, need for multiple surgical procedures, and rhabdomyolysis on admission, compared with nonopioid-related compartment syndrome (NORCS). Methods: We used Current Procedural Terminology codes for fasciotomy as a proxy marker for cases of compartment syndrome treated at 1 health system from January 1, 2016, to December 21, 2018. We excluded patients younger than 18 years, those treated for exertional compartment syndrome, and those who underwent elective fasciotomies. Seventy-four patients met our inclusion criteria. Data reviewed included patient characteristics, cause of compartment syndrome, time until evaluation for compartment syndrome, peak creatinine kinase levels, number of surgical procedures required, duration of hospital stay, and postoperative inpatient morbidity and death. Patients were categorized as having ORCS (n = 8) or NORCS (n = 66). Alpha = .05. Results: All cases of ORCS occurred in men. Opioid use was the third most common cause of compartment syndrome. Two patients underwent amputation, both in the ORCS group (p < 0.01). The median number of debridements was significantly higher for the ORCS group (median, 4; interquartile range [IQR]: 3–6) than for the NORCS group (median, 3; IQR 2–4) (p = 0.03). Duration of hospital stay was longer for the ORCS group (median, 27 days; IQR 16–38) compared with the NORCS group (median, 9 days; IQR: 5–13) (p < 0.001). Mean (± standard deviation) peak creatinine kinase level was significantly higher in the ORCS group (224,000 ± 225,052 U/L) compared with the NORCS group (7550 ± 32,500) (p < 0.001). The proportion of patients who underwent hemodialysis was higher in the ORCS group (88%) than in the NORCS group (35%) (p < 0.001). All ORCS patients presented >8 h after immobilization in a dependent position. Conclusion: Patients in the ORCS group had delayed presentations and significantly more morbidity compared with patients in the NORCS group.

KW - Amputation

KW - Compartment syndrome

KW - Fasciotomy

KW - Hemodialysis

KW - Morbidity

KW - Opioid-related compartment syndrome

KW - Opioids

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