Opioid-related compartment syndrome and associated morbidity

• Published in: Injury 2019-08, Vol.50 (8), p.1429-1432
• Main Authors: Rao, Sandesh S., Mawn, J. Gregory, Lobaton, Gilberto O., Puvanesarajah, Varun, Amin, Raj M., Humbyrd, Casey Jo, Sterling, Robert S.
• Format: Article
• Language: English
• Subjects: Adult; Amputation; Compartment syndrome; Compartment Syndromes - epidemiology; Compartment Syndromes - etiology; Compartment Syndromes - physiopathology; Compartment Syndromes - therapy; Fascia - blood supply; Fascia - injuries; Fasciotomy; Female; Hemodialysis; Heroin Dependence - complications; Heroin Dependence - epidemiology; Heroin Dependence - physiopathology; Heroin Dependence - therapy; Humans; Male; Middle Aged; Morbidity; Opioid-related compartment syndrome; Opioid-Related Disorders - complications; Opioid-Related Disorders - epidemiology; Opioid-Related Disorders - physiopathology; Opioid-Related Disorders - therapy; Opioids; Renal Insufficiency - epidemiology; Retrospective Studies; Rhabdomyolysis - epidemiology; United States - epidemiology; Vascular System Injuries - complications; Vascular System Injuries - epidemiology; Vascular System Injuries - physiopathology; Vascular System Injuries - therapy
• ISSN: 0020-1383; 1879-0267
• DOI: 10.1016/j.injury.2019.06.013

•Patients with ORCS typically present for treatment >8 h after immobilization in a dependent position.•Patients with ORCS have higher peak creatinine kinase levels and more frequently undergo urgent hemodialysis than do patients with NORCS.•ORCS is associated with longer hospital stays and the need for more surgical procedures compared with NORCS. 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). 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. 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