Recidivism in Surgical Intervention for Skin and Soft Tissue Infections from Injection Drug Use: Risks and Patterns

Author(s):
Mary Condron; Elizabeth Dewey; Martin Schreiber

Background:

Part of the opioid epidemic familiar to all General Surgeons is skin and soft tissue infections (SSTI) secondary to injection drug use (IDU).  These infections often require surgical intervention which can range from straight forward incision and drainage all the way to major amputation.  We have anecdotally observed a pattern of surgical recidivism among a subpopulation of these patients. To date, there are no studies examining rates, patterns, or associations of recidivism in surgical treatment of IDU related SSTIs.

Hypothesis:

We propose that there are identifiable patterns in and risk factors for recidivism in SSTI requiring procedural intervention secondary to IDU.

Methods:

10-year retrospective chart review at an urban tertiary referral center of patients with both IDU and surgical treatment of SSTI. Univariate and multivariate analyses were performed to identify associations with repeated surgical encounters. Significance was evaluated at p< 0.05

Results:

2,197 patients meeting inclusion criteria underwent 6,525 surgical encounters during the study period. More than half (1,274) were recidivists. Recidivism was more likely among patients who were older (p=0.02), married (p=0.02), or identified as religious (p<0.0001). Recidivists had longer LOS (p<0.0001) with higher in-hospital mortality (p<0.0001). Among recidivists, each additional procedure was associated with an increased risk of in-hospital mortality of 17% (p<0.0001). Those in the highest quartile of encounters were more likely to be female (p=0.02) and to die during the study period (6.3% vs 12.7%, p<0.0001).

Conclusions:

Patients who underwent multiple surgeries for IDU SSTIs were different: they tended to be older, married, and religious. These findings have important implications for patient care and public policy. We recommend further investigation to determine the impact of delivering additional resources to those at high risk of recidivism.  We would predict that this could reduce patient mortality (as each procedure increases risk of death), decrease healthcare costs, and mitigate provider burnout secondary to repeatedly treating the same problem in the same patient.