A burning issue: Methamphetamine intoxication is associated with graft loss.

INTRODUCTION: Methamphetamine intoxication can lead to medical complications in burn patients, including longer intensive care unit (ICU) stays, sepsis, and more burn debridement procedures. However, its impact on graft durability remains unexplored. We hypothesize that methamphetamine-positive burn patients have higher rates of graft loss. METHODS: A single center retrospective cohort study of patients admitted to the burn service from 2021 to 2024 was performed at an American Burn Association (ABA)-verified burn center. Patients were age 18 years or over, had toxicology screening, and were excluded if not screened for methamphetamine. The primary outcome measured was graft loss requiring return to operating room for re-graft or flap repair. Patient demographics, burn etiology, and use of autograft, along with ICU days, ventilator days, and length of stay were recorded. RESULTS: 746 patients were included in this study with median age 48 years and median total burn surface area burned for the full cohort of 8.35%. 112 patients were methamphetamine-positive. Methamphetamine users had higher rates of autograft loss (p < 0.001), even on logistic regression analysis. Methamphetamine users had increased TBSA (p = 0.01), longer hospital stays (p = 0.03), and increased likelihood of undergoing endotracheal intubation (p = 0.01). Methamphetamine-positive patients presented primarily with flame burns (p < 0.001), while non-users presented primarily with scald burns (p < 0.001). CONCLUSIONS: Methamphetamine-positive burn patients were more likely to sustain flame burns, undergo autografting, and experience graft loss as a complication. Methamphetamine is a unique risk factor for burn patients that increases risk of failing graft management. Routine toxicology testing can promptly identify these patients and notify providers earlier to plan for more intensive burn management.