Self-Reported Cannabis Use Is Associated With a Lower Rate of Persistent Opioid Use After Total Joint Arthroplasty

Hegde, Vishal; Bracey, Daniel N.; Johnson, Roseann M.; Farsad, Yasmin Yazdani; Dennis, Douglas A.

doi:10.1016/j.artd.2022.07.014

Cited by 4 publications

(2 citation statements)

References 38 publications

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“…6 42 43 Conversely, several studies on patients undergoing elective orthopaedic procedures did not demonstrate increased use of prescription opioids. 44 45 46 Therefore, it is interesting to see that marijuana users required more opioids postoperatively in our study, highlighting the complex interplay between marijuana use and postoperative pain. Many individuals, especially cancer patients, use marijuana, either by prescription or recreationally, for pain control.…”

Section: Discussionmentioning

confidence: 76%

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: Discussionmentioning

confidence: 76%

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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show abstract

“…Previous total joint arthroplasty studies examining the potential correlation of cannabis use on perioperative outcomes following surgical procedures have yielded mixed results. Although some suggest that cannabis use was associated with increased risk of postoperative adverse events including myocardial infarction, 9 revision, 24 prolonged length of stay, 37 impaired wound healing, 7 and 90-day costs, 37 other studies have demonstrated cannabis use to be associated with decreased risk of persistent opioid use, 16 and no difference for in-hospital complications or length of stay, 39 and improved wound healing. 7 One recent database study examined outcomes following various orthopaedic procedures among patients with documented cannabis use and found that cannabis users with femur fracture had decreased odds of mortality but increased odds of in-hospital heart failure, and cardiac disease.…”

Section: Introductionmentioning

confidence: 99%

Adverse Events After Ankle Fracture Open Reduction Internal Fixation Among Patients With and Without Documented Cannabis and Tobacco Use

Dhodapkar,

Oghenesume,

Halperin

et al. 2023

Foot Ankle Int.

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Background: Ankle fractures are common orthopaedic injuries that may be indicated for open reduction internal fixation (ORIF). Although the negative impact of tobacco use on perioperative outcomes of ankle fracture ORIF has been described, the potential impact of cannabis use on related outcomes is not as well established. Methods: Retrospective database study of adult patients undergoing ankle ORIF for closed, isolated, ankle fractures from the 2010-2021 Q1 PearlDiver M151 data set. Subcohorts without and with cannabis and/or tobacco use were identified based on coding and matched based on patient age, sex, and Elixhauser Comorbidity Index (ECI) scores to yield groups of nonusers, tobacco users, tobacco and cannabis users, and cannabis users. Ninety-day adverse events were assessed between matched subcohorts with multivariable logistic regression controlling for age, sex, and ECI. Results: A total of 149 289 patients met study inclusion criteria for whom tobacco only use was documented for 14 989 (10.0%), tobacco and cannabis use for 2726 (1.8%), and cannabis only use for 867 (0.6%). Matching yielded 823 for each group. On multivariable analyses, isolated tobacco users were at higher odds of 90-day urinary tract infections (UTIs) (odds ratio [OR] 2.64), minor adverse events (OR 2.33), all-cause adverse events (OR 2.17), readmissions (OR 1.85), and severe adverse events (OR 1.84). Tobacco and cannabis comorbid users were at a marginally higher odds of 90-day UTI (OR 2.82), minor adverse events (OR 2.51), readmissions (OR 2.39), and any adverse events (OR 2.22). Cannabis only users were not at greater odds of 90-day adverse events relative to nonusers. Conclusion: Patients with tobacco use (alone or with cannabis) were at greater odds of 90-day adverse events following ankle fracture ORIF, but cannabis only users were not. Level of Evidence: Level III, Retrospective database study.

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Cannabis and Pain Control After Total Hip and Knee Arthroplasty

Kayani

Howard

Neufeld

et al. 2023

Orthopedic Clinics of North America

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Self-Reported Cannabis Use Is Associated With a Lower Rate of Persistent Opioid Use After Total Joint Arthroplasty

Cited by 4 publications

References 38 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

Adverse Events After Ankle Fracture Open Reduction Internal Fixation Among Patients With and Without Documented Cannabis and Tobacco Use

Cannabis and Pain Control After Total Hip and Knee Arthroplasty

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