Cannabis Use Disorder Linked to perioperative risks and increased mortality

A recent study published in the Journal of American Medical Association found that patients with cannabis use disorder faced a modestly increased risk of perioperative morbidity and mortality after major elective, inpatient, noncardiac surgery.

The research, conducted from January 2016 to December 2019 and analyzed from February to August 2022, included adult patients aged 18 to 65 years who underwent procedures such as cholecystectomy, colectomy, inguinal hernia repair, and joint replacements, among others. The study focused on patients with cannabis use disorder, defined by specific International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnostic codes.

The primary composite outcome measured was in-hospital mortality and seven major perioperative complications, including myocardial ischemia, acute kidney injury, stroke, respiratory failure, venous thromboembolism, hospital-acquired infection, and surgical procedure–related complications, based on ICD-10 discharge diagnosis codes.

In a cohort of 12,422 hospitalizations, researchers matched 6,211 patients with cannabis use disorder with an equal number of patients without cannabis use disorder for analysis. The results indicated that cannabis use disorder was associated with an increased risk of perioperative morbidity and mortality compared to hospitalizations without cannabis use disorder in adjusted analysis (adjusted odds ratio, 1.19; 95% CI, 1.04-1.37; P = .01). The adverse outcome occurred more frequently in the group with cannabis use disorder (7.73%) compared to the unexposed group (6.57%).

The study highlight the importance of preoperative screening for cannabis use disorder as a component of perioperative risk stratification, especially in the context of increasing cannabis use rates in the US. Identifying patients with cannabis use disorder before surgery can help healthcare providers take appropriate precautions and provide necessary support during the perioperative period.

However, the study also emphasizes the need for further research to better understand the perioperative impact of cannabis use, considering factors such as the route of administration and dosage. This information is crucial for developing evidence-based recommendations for preoperative cannabis cessation strategies.

Healthcare providers and policymakers should consider these findings as they develop guidelines and protocols for managing patients with cannabis use disorder before surgery, with an eye towards improving patient safety and outcomes.

Source:

Potnuru, P. P., Jonna, S., & Williams, G. W., II. (2023). Cannabis Use Disorder and Perioperative Complications. In JAMA Surgery (Vol. 158, Issue 9, p. 935). American Medical Association (AMA). https://doi.org/10.1001/jamasurg.2023.2403