RESUMO
Concern exists that liver transplant center substance abuse policies may have an inappropriate and disproportionate impact on marijuana users. Our hypothesis is that patients with chronic liver disease who were marijuana users will have inferior survival. This is a retrospective (1999-2007) cohort study. The primary outcome measure is time-dependent, adjusted patient survival from the time of liver transplant evaluation. The primary exposure variable is a positive cannabinoid toxicology screen during the liver transplant evaluation period. Overall, 155 patients qualified as marijuana users while 1334 patients were marijuana non-users. Marijuana users were significantly (p < 0.05) younger (48.3 vs. 52.1), more likely to be male (78.1% vs. 63.0%), have hepatitis C (63.9% vs. 40.6%) and were less likely to receive a transplant (21.8% vs. 14.8%). Marijuana users were more likely to use tobacco, narcotics, benzodiazepines, amphetamines, cocaine or barbiturates (p < 0.05). Unadjusted survival rates were similar between cohorts. Upon multivariate analysis, MELD score, hepatitis C and transplantation were significantly associated with survival, while marijuana use was not (HR 1.09, 95% CI 0.78-1.54). We conclude that patients who did and did not use marijuana had similar survival rates. Current substance abuse policies do not seen to systematically expose marijuana users to additional risk of mortality.
Assuntos
Sobrevivência de Enxerto , Transplante de Fígado/mortalidade , Abuso de Maconha/epidemiologia , Fumar Maconha , Doença Crônica , Estudos de Coortes , Feminino , Humanos , Hepatopatias/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
A time/motion study performed in the Department of Anesthesiology at Ohio State University divided intraoperative events into three categories: (1) patient-centered, direct--activities that direct the anesthesiologist's attention to the patient; (2) patient-centered, indirect--observation of equipment or data related to patient status; and (3) non-patient-centered--activities that direct the anesthesiologist's attention away from the patient. Surprisingly, results of this study did not differ greatly from those of earlier investigators, who found that the anesthesiologist was distracted from the patient 46% of the time. Future studies and monitor development should address this problem by reducing non-patient-centered activities and distractions to the anesthesiologist during surgery.
