O-165 - A RETROSPECTIVE REVIEW OF THE HEALTH IMPACT OF INJECTING DRUG USE AND THE COLLATERAL CONSEQUENCES FOR VASCULAR SURGERY: THE EAST OF SCOTLAND EXPERIENCE

TOPIC:
Vascular Trauma
AUTHORS:
Macleod C. (East of Scotland Vascular Network ~ Dundee ~ United Kingdom) , O'Neill H. (East of Scotland Vascular Network ~ Dundee ~ United Kingdom) , Flett M. (East of Scotland Vascular Network ~ Dundee ~ United Kingdom) , Guthrie G. (East of Scotland Vascular Network ~ Dundee ~ United Kingdom) , Nagy J. (East of Scotland Vascular Network ~ Dundee ~ United Kingdom) , Suttie S. (East of Scotland Vascular Network ~ Dundee ~ United Kingdom)
Introduction:
Scotland has the highest drug deaths rate in Europe, and potentially the world, constituting a public health emergency. Underlying this mortality is morbidity. People who inject drugs (PWID) are at risk of a range of injecting-related injuries and infections that can threaten both life and limb. These complications can include perivascular soft tissue sepsis, complex groin collections extending into the retroperitoneum and infected arterial pseudoaneurysms. These pathologies can lead to the need for expensive, emergency healthcare, posing a particular burden for surgical specialities, especially vascular surgery. This study aimed to characterise hospital admissions for limb-related complications secondary to injecting drug use to enable a better comprehension of the patterns and presentations of injecting injuries.
Methods:
Retrospective data collection between December 2011-December 2020. Patients were identified through discharge codes and a prospective operative unit database. Demographic and admission details were extracted from electronic records and a database created. Two diagnoses could be recorded for each admission, reflecting the realities of clinical practice. Descriptive statistical analyses were performed.
Results:
There were 805 admissions for 445 patients (1-10 admissions/patient): mean age 37.5 (21.2-61.5) years and 488 (60.6%; 277 patients, 61.9%) were male. Admissions were generated by: 333 groin abscesses; 75 other abscesses; 109 pseudoaneurysms; 126 necrotising soft tissue infections (NSTI); 137 cellulitis cases; 168 deep venous thromboses (DVT); 59 infected DVTs and 138 other pathologies. Overall 570 (70.8%) admissions were cared for by surgical specialities, with most, 412, under vascular surgery. Surgery was required for 409 (50.8%) admissions, with 534 operations performed (1-7/admission). There were 31 major lower limb amputations. The mean length of hospital stay was 10.29 (0-105) days, comprising a mean of 9.92 (0-105) days on the ward, 0.26 (0-28) days in the high dependency unit (HDU) and 0.11 (0-15) days in the intensive care unit (ICU). During follow-up 97 (21.8%) patients died with a mean age of 43.6 (26.8-62.8) years.
Conclusion:
Limb-related morbidity secondary to injecting drug use can represent a considerable surgical workload, particularly for vascular surgery. These injecting-related complications can reflect complex, high-tariff pathology with substantial emergency healthcare needs.