1431. The Changing Landscape of Neurosurgical Injury in the Context of Drugs of Abuse, a Retrospective Analysis of 2012 and 2017

Authors: Paul J. Yager; Laura Hornback; Wesley Barnett; Christina Pistilli; Farhan Mirza, MD; Raul Vasquez (Lexington, KY)

Introduction:

The impact of recreational drug use has been felt in Kentucky for the last decade; however, no efforts to quantify the effects on the field of neurosurgery have been made. Recently, drug use has been proposed as a major driver for the growing rate of spinal infections in Washington. This is a formidable clinical entity with mortality approaching 20% for this cluster of diseases including spinal epidural abscess, discitis, and osteomyelitis. Delving deeper into this population of patients in order to see the full effect of drug use, the changes in drug use, and the impact it has on the field of neurosurgery is warranted. 

Methods:

IRB approved, retrospective cross sectional study of a 2012 and 2017 neurosurgery census. The daily census was meticulously combed for patients with a history of drug use (laboratory values, HPI elements, or discharge diagnoses). Data was entered into RedCap. Deidentified data was analyzed.

Results:

Forty-five consecutive days of data from 2012 and 2017 were analyzed (94 patients). In 2017 an increase in methamphetamine, cocaine, heroin, and fentanyl use and an increase in mortality was found. The increase in substance use was most pronounced on laboratory findings. Consults were primarily related to trauma. Two mycotic aneurysms with concurrent endocarditis were found in the 2017 series. Notably there was one epidural abscess requiring drainage in both 2012 and 2017.

Conclusion:

The data described shows an increase in drugs of abuse and an increase in mortality for patients using drugs. An increase in infections from 2012 to 2017 suggests a rising problem. Clinically, changes in drug use were more pronounced on laboratory findings than on patient report (HPI) which shows the need for continued high suspicion by the physician. This study provides a stepping stone for future data collection.