The association between cannabis use disorder and the outcome following primary total hip arthroplasty

Abstract

Aims Although there is increasing legalization of the use of cannabis in the USA, few well-powered studies have evaluated the association between cannabis use disorder and outcomes following primary total hip arthroplasty (THA). Thus, the aim of this study was to determine whether patients who use cannabis and undergo primary THA have higher rates of in-hospital length of stay (LOS), medical complications, implant-related complications, and costs. Methods Using an administrative database, patients with cannabis use disorder undergoing primary THA were matched to a control group in a 1:5 ratio by age, sex, and various medical comorbidities. This yielded 23,030 patients (3,842 in the study group matched with 19,188 in the control group). The variables which were studied included LOS, 90-day medical complications, two-year implant-related complications, and 90-day costs of care. Mann-Whitney U tests were used to compare LOS and costs. Multivariate logistic regression analyses were used to calculate the odds ratios (ORs) of developing complications. Results We found that patients in the study group had a significantly longer mean LOS compared with the controls (four days vs three days; p < 0.0001).The study group also had a significantly higher incidence and odds of developing medical (23.0 vs 9.8%, OR 1.6; p < 0.0001) and implant-related complications (16 vs 7.4%, OR 1.6; p < 0.0001) and incurred significantly higher mean 90-day costs ($16,938.00 vs $16,023.00; p < 0.0001). Conclusion With the increasing rates of cannabis use, these findings allow orthopaedic surgeons and other healthcare professionals to counsel patients with cannabis use disorder about the possible outcomes following their THA, with increased hospital stays, complications, and costs. Cite this article: Bone Joint J 2021;103-B(7 Supple B):111–115.

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

“…Analysis of economic outcomes revealed that CUD patients had significantly shorter length of stay (LOS) and higher rates of home discharge following primary TJA compared to the control group. This contrasted with previous reports of increased LOS for patients with CUD following primary TJA [ 13 , 45 ]. Differences in statistical methodology likely account for these differences, as this study's propensity weighting methodology allowed for controlling a large number of potentially confounding factors for LOS and discharge disposition.…”

“…While cannabis use may conceivably be beneficial in the postoperative setting, cannabis use disorder (CUD), defined in part as a problematic pattern of cannabis use leading to clinically significant impairment or distress, has been correlated with increased postoperative pain and opioid use following orthopedic surgical procedures [ 6 – 12 ]. It remains unclear what potential utilization and implication the cannabis use has on postoperative clinical and economic outcomes of patients undergoing major elective surgery, such as total joint arthroplasty (TJA) [ 2 , 3 , 10 , 11 , 13 ]. The relevant literature on this topic has yielded conflicting results, while being complicated by a patient population that is constantly evolving in the context of social and legal changes leading to increased cannabis use [ 14 ].…”

Cannabis Use Disorder in the Setting of Primary Total Hip Arthroplasty: Understanding the Epidemiology, Demographic Characteristics, and Inpatient Postoperative Outcomes

“…1,3 However, our findings contrast with a recent study demonstrating an increase in medical complications and LOS in patients with CUD after primary THA. 11 These differences are likely related to statistical methodologic differences, as our IPTW methodology provides a robust theoretical matching technique for demographics and Elixhauser Comorbidity Index without the loss of large volumes of data. Overall, however, the literature generally trends toward somewhat a consensus that CUD does not seem to affect perioperative outcomes after arthroplasty.…”

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

“…Smoking cannabis has been associated with a dose-dependent impairment of large airway function resulting in airflow obstruction and hyperinflation, but it has seldom been associated with frank emphysema 103–106. Of critical importance to the anesthesiologist are the effects that justify postponement of surgery.…”

“…90 100-102 Smoking cannabis has been associated with a dose-dependent impairment of large airway function resulting in airflow obstruction and hyperinflation, but it has seldom been associated with frank emphysema. [103][104][105][106] Of critical importance to the anesthesiologist are the effects that justify postponement of surgery. The limited available evidence suggests that the airway inflammation following marijuana smoking is similar to that following tobacco.…”