Prevalence and Association of Non-medical Cannabis Use with Post-procedural Healthcare Utilisation in Patients Undergoing Surgery or Interventional Procedures: a Retrospective Cohort Study

Overview

Journal EClinicalMedicine

Specialty General Medicine

Date 2023 Feb 17

PMID 36798752

Authors

Elena Ahrens

Luca J Wachtendorf

Laetitia S Chiarella

Sarah Ashrafian

Aiman Suleiman

Tim M Tartler

Basit A Azizi

Guanqing Chen

Amnon A Berger

Denys Shay

Bijan Teja

Valerie Banner-Goodspeed

Haobo Ma

Matthias Eikermann

Kevin P Hill

Maximilian S Schaefer

Affiliations

Soon will be listed here.

Abstract

Background: There is paucity of data regarding prevalence and key harms of non-medical cannabis use in surgical patients. We investigated whether cannabis use in patients undergoing surgery or interventional procedures patients was associated with a higher degree of post-procedural healthcare utilisation.

Methods: 210,639 adults undergoing non-cardiac surgery between January 2008 and June 2020 at an academic healthcare network in Massachusetts, USA, were included. The primary exposure was use of cannabis, differentiated by reported ongoing non-medical use, self-identified during structured, preoperative nursing/physician interviews, or diagnosis of cannabis use disorder based on International Classification of Diseases, 9th/10th Revision, diagnostic codes. The main outcome measure was the requirement of advanced post-procedural healthcare utilisation (unplanned intensive care unit admission, hospital re-admission or non-home discharge).

Findings: 16,211 patients (7.7%) were identified as cannabis users. The prevalence of cannabis use increased from 4.9% in 2008 to 14.3% by 2020 (p < 0.001). Patients who consumed cannabis had higher rates of psychiatric comorbidities (25.3 versus 16.8%; p < 0.001) and concomitant non-tobacco substance abuse (30.2 versus 7.0%; p < 0.001). Compared to non-users, patients with a diagnosis of cannabis use disorder had higher odds of requiring advanced post-procedural healthcare utilisation after adjusting for patient characteristics, concomitant substance use and socioeconomic factors (aOR [adjusted odds ratio] 1.16; 95% CI 1.02-1.32). By contrast, patients with ongoing non-medical cannabis use had lower odds of advanced post-procedural healthcare utilisation (aOR 0.87; 95% CI 0.81-0.92, compared to non-users).

Interpretation: One in seven patients undergoing surgery or interventional procedures in 2020 reported cannabis consumption. Differential effects on post-procedural healthcare utilisation were observed between patients with non-medical cannabis use and cannabis use disorder.

Funding: This work was supported by an unrestricted philantropic grant from Jeff and Judy Buzen to Maximilian S. Schaefer.

Citing Articles

Considerations for Anesthesia in Older Adults with Cannabis Use.

Ahrens E, Wachtendorf L, Hill K, Schaefer M Drugs Aging. 2024; 41(12):933-943.

PMID: 39617807 DOI: 10.1007/s40266-024-01161-6.

Role of anticoagulation therapy in modifying stroke risk associated with new-onset atrial fibrillation after non-cardiac surgery.

Azimaraghi O, Rudolph M, Wongtangman K, Borngaesser F, Doehne M, Ng P Nat Med. 2024; 30(11):3310-3317.

PMID: 39179854 DOI: 10.1038/s41591-024-03206-0.

References

Zhang B, Saud H, Sengupta N, Chen M, Bakshi D, Richardson L . Effect of preoperative cannabis use on perioperative outcomes: a retrospective cohort study. Reg Anesth Pain Med. 2021; 46(8):650-655. DOI: 10.1136/rapm-2021-102479. View

Goel A, McGuinness B, Jivraj N, Wijeysundera D, Mittleman M, Bateman B . Cannabis Use Disorder and Perioperative Outcomes in Major Elective Surgeries: A Retrospective Cohort Analysis. Anesthesiology. 2019; 132(4):625-635. DOI: 10.1097/ALN.0000000000003067. View

Hill K . Cannabis Use and Risk for Substance Use Disorders and Mood or Anxiety Disorders. JAMA. 2017; 317(10):1070-1071. DOI: 10.1001/jama.2016.19706. View

Wachtendorf L, Azimaraghi O, Rangasamy V, Sane M, Subramaniam B, Vazquez R . Preoperative Treatment of Severe Diabetes Mellitus and Hypertension Mitigates Healthcare Disparities and Prevents Adverse Postoperative Discharge to a Nursing Home. Ann Surg. 2022; 276(3):e185-e191. DOI: 10.1097/SLA.0000000000005544. View

Swetlik C, Migdady I, Hasan L, Buletko A, Price C, Cho S . Cannabis Use and Stroke: Does a Risk Exist?. J Addict Med. 2021; 16(2):208-215. DOI: 10.1097/ADM.0000000000000870. View

Rzasa Lynn R, Galinkin J . Cannabis, e-cigarettes and anesthesia. Curr Opin Anaesthesiol. 2020; 33(3):318-326. DOI: 10.1097/ACO.0000000000000872. View

Kraft B, Stromer W . [The effects of cannabis and cannabinoids on anesthesia and analgesia during the perioperative period]. Schmerz. 2020; 34(4):314-318. DOI: 10.1007/s00482-020-00449-x. View

Ladha K, Mistry N, Wijeysundera D, Clarke H, Verma S, Hare G . Recent cannabis use and myocardial infarction in young adults: a cross-sectional study. CMAJ. 2021; 193(35):E1377-E1384. PMC: 8443297. DOI: 10.1503/cmaj.202392. View

Lucatch A, Coles A, Hill K, George T . Cannabis and Mood Disorders. Curr Addict Rep. 2019; 5(3):336-345. PMC: 6329464. DOI: 10.1007/s40429-018-0214-y. View

10.

Lorenzetti V, Hoch E, Hall W . Adolescent cannabis use, cognition, brain health and educational outcomes: A review of the evidence. Eur Neuropsychopharmacol. 2020; 36:169-180. DOI: 10.1016/j.euroneuro.2020.03.012. View

11.

Banerjee A, Gandhi A, Antony I, Alexander J, Hisbulla M, Kannichamy V . Role of Cannabis in the Incidence of Myocardial Infarction: A Review. Cureus. 2020; 12(10):e11097. PMC: 7681753. DOI: 10.7759/cureus.11097. View

12.

Manseau M, Goff D . Cannabinoids and Schizophrenia: Risks and Therapeutic Potential. Neurotherapeutics. 2015; 12(4):816-24. PMC: 4604190. DOI: 10.1007/s13311-015-0382-6. View

13.

Scheffenbichler F, Teja B, Wongtangman K, Mazwi N, Waak K, Schaller S . Effects of the Level and Duration of Mobilization Therapy in the Surgical ICU on the Loss of the Ability to Live Independently: An International Prospective Cohort Study. Crit Care Med. 2021; 49(3):e247-e257. PMC: 7902391. DOI: 10.1097/CCM.0000000000004808. View

14.

Marconi A, Di Forti M, Lewis C, Murray R, Vassos E . Meta-analysis of the Association Between the Level of Cannabis Use and Risk of Psychosis. Schizophr Bull. 2016; 42(5):1262-9. PMC: 4988731. DOI: 10.1093/schbul/sbw003. View

15.

Petrilli K, Ofori S, Hines L, Taylor G, Adams S, Freeman T . Association of cannabis potency with mental ill health and addiction: a systematic review. Lancet Psychiatry. 2022; 9(9):736-750. DOI: 10.1016/S2215-0366(22)00161-4. View

16.

Suleiman A, Munoz-Acuna R, Azimaraghi O, Houle T, Chen G, Rupp S . The effects of sugammadex vs. neostigmine on postoperative respiratory complications and advanced healthcare utilisation: a multicentre retrospective cohort study. Anaesthesia. 2022; 78(3):294-302. DOI: 10.1111/anae.15940. View

17.

Mathur M, Ding P, Riddell C, VanderWeele T . Web Site and R Package for Computing E-values. Epidemiology. 2018; 29(5):e45-e47. PMC: 6066405. DOI: 10.1097/EDE.0000000000000864. View

18.

Rumalla K, Reddy A, Mittal M . Recreational marijuana use and acute ischemic stroke: A population-based analysis of hospitalized patients in the United States. J Neurol Sci. 2016; 364:191-6. DOI: 10.1016/j.jns.2016.01.066. View

19.

Schaefer M, Hammer M, Platzbecker K, Santer P, Grabitz S, Murugappan K . What Factors Predict Adverse Discharge Disposition in Patients Older Than 60 Years Undergoing Lower-extremity Surgery? The Adverse Discharge in Older Patients after Lower-extremity Surgery (ADELES) Risk Score. Clin Orthop Relat Res. 2020; 479(3):546-547. PMC: 7899493. DOI: 10.1097/CORR.0000000000001532. View

20.

Moore T, Zammit S, Lingford-Hughes A, Barnes T, Jones P, Burke M . Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet. 2007; 370(9584):319-28. DOI: 10.1016/S0140-6736(07)61162-3. View