Analysis of postoperative complications related to cannabis and tobacco usage in patients undergoing mandible facial fracture surgeries

Yoon, YooJin; Lee, Nayun; Lee, Anna; Gehring, Michael B.; Constantine, Ryan; Mathes, David W.; Yu, Jack C.; Khechoyan, David Y.; Iorio, Matthew L.; Kaoutzanis, Christodoulos

doi:10.1016/j.bjps.2023.06.067

Cited by 3 publications

(2 citation statements)

References 26 publications

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“…Second, there are mixed results regarding the interaction of marijuana and nicotine usage, with some reports suggesting that concomitant use of marijuana and nicotine further elevates postoperative complication risks compared to nicotine use alone. 2,9,36,37 The question of whether marijuana use independently increases a patient's risk of flap complications or potentiates the negative effects of nicotine use is of great interest in the plastic surgery literature and will require further clinical study.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

The Impact of Marijuana Use on Postoperative Outcomes in Abdominal-based Free Flap Breast Reconstruction

Lu,

Mahajan,

Rudy

et al. 2024

J Reconstr Microsurg

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Background: There is an increasing prevalence of marijuana use in the general population yet clinical studies on marijuana’s effect on surgical outcomes remain limited. Marijuana’s effect on wound healing, venous thromboembolism due to endothelial inflammation, and bleeding due to inhibited platelet function have been cited based on animal models but have not been evaluated clinically in patients undergoing microsurgical reconstruction. Methods: Retrospective chart review was performed on all patients who underwent abdominal-based free flap breast reconstruction in a single institute from August 2018 to December 2022. Patient self-reported marijuana use, demographics, total narcotic use during hospitalization converted to oral morphine milligram equivalent (MME), and 90-day complications were collected and compared. Results: Total of 162 patients were included and 13 patients (8.5%) had reported marijuana use on pre-surgical history. Marijuana users are more likely to be younger and report concurrent nicotine smoking. Marijuana users were also at a significantly elevated risk of developing symptomatic venous thromboembolism (15% vs 1%; OR13.4 [95%CI 1.71-104.2], p=0.01) and marijuana use remained a significant risk factor with multivariate analysis. On postoperative 90-day complications, there was no increased risk of flap loss, re-operation, post-operative transfusion, or hematoma associated with marijuana use, and no significantly increased risk for overall donor or recipient site complications. Marijuana users required significantly more narcotics for pain control during hospitalization (100 ±77 MME vs 49 ±45 MME; p=0.0003), although they had similar lengths of stay, achievement of mobilization on POD1, and maximal pain scores. Conclusion: Marijuana use increases the risks of postoperative venous thromboembolism and increased postoperative narcotic requirements in patients who underwent abdominal based free flap breast reconstruction. Future prospective cohort study is required to further understand marijuana associated risks in microsurgical procedures.

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Section: Accepted Manuscriptmentioning

confidence: 99%

The Impact of Marijuana Use on Postoperative Outcomes in Abdominal-based Free Flap Breast Reconstruction

Lu,

Mahajan,

Rudy

et al. 2024

J Reconstr Microsurg

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“…Although the individual effects of alcohol and nicotine use are well-documented, data regarding their couse are still limited. A study investigating the simultaneous use of tobacco and marijuana revealed that, although the risk of complications was elevated in both the tobacco-only and tobacco-marijuana combination groups compared with cannabis use alone, the risk was notably higher in the tobacco-only group when compared with the combination group 41 . This intriguing finding supports the hypothesis that marijuana may enhance nicotine levels in the body, potentially aiding in smoking cessation 42 .…”

Section: Safety Considerationsmentioning

confidence: 99%

Unlocking the Healing Potential

Shahzad,

Lee,

Munjal

et al. 2023

JBJS Reviews

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» Cannabinoids, such as D9-tetrahydrocannabinol and cannabidiol, interact with endocannabinoid receptors in the central nervous system and immune system, potentially offering pain relief. The entourage effect, resulting from the interaction of multiple cannabis components, may enhance therapeutic impact and efficacy, making them promising candidates for exploring pain relief in spine operations, known to be among the most painful operative procedures.» The use of cannabinoids in pain management requires careful consideration of safety, including their cognitive and psychomotor effects, potential cardiovascular risks, risk of dependence, mental health implications, and drug interactions.» Few studies have analyzed cannabinoid use in relation to spine surgery, with variable results reported, indicating possible effects on reoperation rates, mortality, complications, postoperative opioid use, and length of hospital stay.» Current knowledge gaps exist in the understanding of cannabinoid effects on spine surgery, including the exploration of different administration routes, timing, dosage, and specific outcomes. In addition, mechanistic explanations for the observed results are lacking.» Ethical considerations related to informed consent, medical expertise, societal impact, and legal compliance must also be thoroughly addressed when considering the utilization of cannabinoids in spinal pathologies and back pain treatment.

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Surgery-Related Considerations in Treating People Who Use Cannabis

Mims,

Parikh,

Sandhu

et al. 2024

JAMA Otolaryngol Head Neck Surg

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ImportanceCannabis use has experienced substantial growth. Many patients treated by otolaryngologists are using cannabis in various forms, often without the knowledge of the treating surgeon. These cannabinoid substances have various systemic effects, and it is critical for otolaryngologists to recognize how cannabis use may contribute to a patient’s care.ObservationsCannabis use has effects that contribute to every phase of a surgeon’s care. Preoperative counseling for tapering use may prevent increased rates of adverse effects. Care with anesthesia must be observed due to increased rates of myocardial ischemia, higher tolerance to standard doses, and prolonged sedation. Although results of studies are mixed, there may be an association with cannabis use and postoperative pain, nausea, and vomiting. Postoperative wound healing may be improved through the use of topical cannabinoids. Significant drug-drug interactions exist with cannabis, most notably with several common anticoagulant medications. Care should be exercised when managing medications for people who use cannabis. While many people who use cannabis consume it infrequently, a substantial population has developed cannabis use disorder, which is associated with increased morbidity and mortality postoperatively. Screening for cannabis use disorder is important and can be done through short screening tools.Conclusions and RelevancePatients who use cannabis may require special attention regarding preoperative counseling and workup, intraoperative anesthesia, postoperative pain management, nausea, wound healing, and drug-drug interactions. As patient use continues to increase, otolaryngologists will find an increasing need to remain up to date on how cannabis use contributes to patient care.

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Analysis of postoperative complications related to cannabis and tobacco usage in patients undergoing mandible facial fracture surgeries

Cited by 3 publications

References 26 publications

The Impact of Marijuana Use on Postoperative Outcomes in Abdominal-based Free Flap Breast Reconstruction

The Impact of Marijuana Use on Postoperative Outcomes in Abdominal-based Free Flap Breast Reconstruction

Unlocking the Healing Potential

Surgery-Related Considerations in Treating People Who Use Cannabis

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