Cannabis use tied to increased risk of perioperative complications and mortality: JAMA

USA: A recent study published in JAMA Surgery has found an association between cannabis use disorder (CUD) and an increased risk of patient morbidity and in-hospital mortality after major elective, noncardiac, inpatient surgery.

Researchers with UTHealth Houston found that patients with CUD are approximately 20% more likely to experience a significant postoperative complication than patients without CUD.

Nearly 16.3 million people had a cannabis use disorder (CUD) in 2021, according to the National Institute on Drug Abuse. Defined by the Centers for Disease Control and Prevention, cannabis use disorder occurs when someone is unable to stop using cannabis even though it is causing health and social problems in their lives.

“A significant number of patients' first encounter with the health care system is for surgery. Most have other health-related issues like high blood pressure and diabetes that they may not have previously known about. Cannabis use falls into the category of a health-related issue. It may not be as harmless as people think; it can have a significant impact on your health,” said Paul Potnuru, MD, first author of the study and assistant professor in the Department of Anesthesiology, Critical Care and Pain Medicine at McGovern Medical School at UTHealth Houston.

Using the National Inpatient Sample Database, researchers analyzed 62,110 hospitalizations from major elective inpatient surgeries performed in the United States from 2016 to 2019.

According to the study, patients with CUD had an increased risk of postoperative complications, including myocardial ischemia, acute kidney injury, stroke, respiratory failure, venous thromboembolism, hospital-acquired infection, and surgical procedure-related complications. Additionally, hospital stay cost was higher in patients with CUD than those without it.

With the growing rate of cannabis use and increasing potency of cannabis products, Potnuru said there are safety concerns for patients with frequent use of cannabis who undergo surgery. Earlier this year, the American Society of Regional Anesthesia and Pain Medicine released new guidelines for screening cannabis use in all patients before surgery. It recommended informing them of the increased risk of adverse outcomes.

“From the anaesthesia perspective, cannabis users may need higher doses of anaesthetic medications during surgery. They can also have higher pain levels after surgery and require more opioids. Doctors must be aware of the level of a patient’s cannabis usage to tailor the number of medications given and closely monitor for complications,” Potnuru said.

Reference:

Potnuru PP, Jonna S, Williams GW. Cannabis Use Disorder and Perioperative Complications. JAMA Surg. Published online July 05, 2023. doi:10.1001/jamasurg.2023.2403.