Cannabis use disorder is associated with shorter length of stay and increased home discharge after primary total joint arthroplasty: a propensity-weighted analysis

Abstract

Introduction Increased legalization of cannabis use across the United States has been correlated with increased cannabis use in the clinical setting. However, little is known regarding the characteristics and postoperative outcomes after primary joint arthroplasty (TJA) for patients with cannabis use disorder (CUD). Methods This retrospective cohort study used data from the National Inpatient Sample of patients undergoing primary TJA between 2006 to 2015. Patients were grouped based on presence of concomitant CUD. Patient demographic characteristics and outcome data between groups were analyzed. Propensity score methodology was used to compare immediate in-hospital complications and economic outcomes. Results A total of 8,740,798 TJAs were included. The prevalence of CUD increased nearly five-fold from 0.05% to 0.26% during this time (P < 0.0001). CUD patients were significantly younger, more likely to be male, most frequently of non-Hispanic Black race, and had higher rates of Medicaid insurance. Patients with CUD had a significantly shorter length of hospital stay (3.04 vs. 3.24 days, P = 0.0297), while incurring significantly higher daily ($22,614 vs. $17,955, P < 0.0001) and total charges during admission ($58,507 vs. $50,924, P < 0.0001), compared to patients without CUD. When compared with the control group, CUD was associated with significantly greater odds of home discharge (odds ratio (OR): 1.45, P = 0.0007), and significantly lower odds of rehab discharge (OR: 0.70, P = 0.0013). There were no differences in overall complication profile or in the vast majority of individual in-hospital complications between groups. Conclusion While CUD is correlated to shorter length of stay and increased home discharge after TJA, it does not show a strong effect on complications in an inpatient postoperative setting. It is important for clinicians to appreciate the demographic profile and expected clinical and economic outcomes for patients with CUD undergoing TJA, particularly in the context of evolving laws surrounding cannabis use.

Cannabis use disorder and perioperative outcomes following complex cancer surgery

“…CUD was associated with a lower likelihood of an extended length of stay, as well as an increased chance to be discharged home or leave against medical advice. While the reasons for these findings are multifactorial, patients dependent on cannabis use may be incentivized to leave the hospital sooner and return home to resume cannabis and other substance use 54 . While the current study did not examine readmission or postdischarge complications, other data have suggested the CUD may lead to postoperative, postdischarge health risks due to behavioral changes and reduced engagement in social or occupational activities 54 .…”

“…54 While the current study did not examine readmission or postdischarge complications, other data have suggested the CUD may lead to postoperative, postdischarge health risks due to behavioral changes and reduced engagement in social or occupational activities. 54 In turn, while data from the current study demonstrated no association with in-hospital risk of morbidity or mortality, future studies need to assess long-term outcomes and general health of cancer patients relative to long-term cannabis use. Surgeons and healthcare teams should be mindful of discussing the usage of cannabis with patients, understanding that these discussions can often be complex due to social, cultural, and regulatory factors.…”

“…While the reasons for these findings are multifactorial, patients dependent on cannabis use may be incentivized to leave the hospital sooner and return home to resume cannabis and other substance use 54 . While the current study did not examine readmission or postdischarge complications, other data have suggested the CUD may lead to postoperative, postdischarge health risks due to behavioral changes and reduced engagement in social or occupational activities 54 . In turn, while data from the current study demonstrated no association with in‐hospital risk of morbidity or mortality, future studies need to assess long‐term outcomes and general health of cancer patients relative to long‐term cannabis use.…”

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

“…11,21 This effect has been associated with an elevated risk of perioperative cardiovascular complications 5 and VTE in trauma 22 and orthopaedic patients. 23 Among plastic and reconstructive surgeons, DVT remains a concerning complication. Breast reconstruction patients face an elevated baseline risk of VTE due to underlying malignancy, prolonged procedure times, and the necessity for postoperative hospitalization, with incidence reported between 0.13 and 6% amongst various studies.…”