Toxicology Screening Testing in Spine Surgical Patients: A Prospective Observational Pilot Study
A
Short CommunicationClaudia F. Clavijo, MD, Anthony M. Oliva, MD, PhD, Colleen Dingmann, RN, PhD, Alex Kaizer, PhD, Uwe Christians, MD, PhD, Evalina Burger, MD, Vikas Patel, MD, Christopher J. Kleck, MD, Scott A. Vogel, DO, Benjamin K. Scott, MD, Daniel J. Janik, MD,
Leslie C. Jameson, MD, Adit A. Ginde, MD, MPH
SUPPLEMENTAL DIGITAL CONTENTS
Table S1. Patient demographics
Variables n= % Mean Median
Age 57.2 59
Gender
Male 10 37.1
Female 17 62.9
BMI 30.6 27.8
Current smoker Yes 6 22.2
No 21 77.8
Current marijuana user Yes 5 18.5
No 22 81.5
Current daily/frequent alcohol user Yes 8 29.6
No 19 70.4
Number of positive drugs in TST 0 1 3.7
1 5 18.5
2 8 29.6
3 2 7.4
4 5 18.5
5 1 3.7
6 3 11.1
7 2 7.4
ICU admission Yes 5 18.5
No 22 81.5
Length of stay (days) 27 4.3 4.0
0 - 4 17 62.9
4 -8 6 22.2
8 -12 2 7.4
> 12 2 7.4
Number of medications per patient
prior to surgery 11.7 12.0
0 - 4 3 11.1
4 -8 5 18.5
8 -12 6 22.2
12 - 16 9 33.3
> 16 4 14.8
Table S2. Frequency heat map of the induction doses of propofol (intra-operative, in mg), pain scores in relationship to the number of positive toxicology (tox) screening results for a given participant.
The data was analyzed using Spearman correlation. For the number of the number of positive drugs in the toxicology screen and the induction dose, correlation coefficient was r= 0.509 suggesting a moderately strong positive monotonic relationship. In other words, as the number of positive substances from the toxicology screen increases, the corresponding recorded dose of intra-operative propofol tended to increase.
Table S3. Comparison of clinical outcomes parameters in patients testing positive or negative for marijuana or alcohol use in the toxicology screening test.
Alcohol and marijuana are shown here as representative examples. Outcome parameters between groups was compared using the non-parametric Kruskal Wallis test.
Abbreviations: IQR: interquartile range (25%, 75%), PACU: post anesthesia care unit, TST: toxicology screening test. Five out of 27 patients tested positive for marijuana and 8 out of 27 for alcohol. Pain is reported as pain scores on a scale from 0-10. Although there were trends towards higher intra-operative propofol and fentanyl use, none of these differences were statistically significant, most likely due to the small numbers of observation. Nevertheless, the data suggests that the relationship between pre-operative drug use confirmed by toxicology screening rather than self-report and intra-operative use of anesthetics as well as post-operative pain and other clinical outcome parameters needs to be further assessed in a sufficiently powered, prospective clinical trial.
Substance Outcome parameter Positive TST Negative TST Kruskal- Wallis
median (IQR) median (IQR) p-value
Alcohol
Total propofol dose (mg) 225 (200, 262.) 180 (150, 200) 0.117 Total fentanyl dose (µg) 200 (200, 200) 150 (112.5, 212.5) 0.189
PACU maximum pain 7 (4, 8) 7 (6.5, 9) 0.432
Day 1 maximum pain 7 (5.5, 9.5) 6 (5, 8) 0.941
Day 2 maximum pain 7 (4.75, 9.25) 6.6 (4, 7.75) 0.249
Marijuana
Total propofol dose (mg) 250 (200, 250) 190 (150, 200) 0.185 Total fentanyl dose (µg) 200 (150, 200) 200 (150, 218.8) 0.967
PACU maximum pain 4 (4, 7) 7.5 (7, 9) 0.176
Day 1 maximum pain 6.5 (5.5, 7.75) 6.5 (5, 9) 0.799
Day 2 maximum pain 7 (6.2, 7.75) 6.5 (4, 8) 0.726
