Opioid-related compartment syndrome and associated morbidity.
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.
['Rao|Sandesh S|SS|', 'Mawn|J Gregory|JG|', 'Lobaton|Gilberto O|GO|', 'Puvanesarajah|Varun|V|', 'Amin|Raj M|RM|', 'Humbyrd|Casey Jo|CJ|', 'Sterling|Robert S|RS|']
D000328:Adult D003161:Compartment Syndromes D005205:Fascia D000071938:Fasciotomy D005260:Female D006556:Heroin Dependence D006801:Humans D008297:Male D008875:Middle Aged D009293:Opioid-Related Disorders D051437:Renal Insufficiency D012189:Retrospective Studies D012206:Rhabdomyolysis D014481:United States D057772:Vascular System Injuries
Opioid-related compartment syndrome Compartment syndrome Morbidity Opioids Amputation Fasciotomy Hemodialysis