Impact of Cannabis Use on Outcomes after Lower Extremity Bypass

Marijuana Use Increases the Risk of Postoperative Bleeding in Patients Undergoing Abdominal Body Contouring

BACKGROUND

The legalization and changing perception of marijuana have led to a significant increase in its use. Although studies exploring marijuana's physiological effects have grown, its effect on surgical outcomes remains unclear. This study investigates the influence of marijuana consumption on postoperative complications in patients undergoing abdominal body contouring surgeries such as abdominoplasties and panniculectomies.

METHODS

A retrospective chart review was conducted on patients who underwent abdominal body contouring procedures at an urban academic institution from 2016 to 2021. Data collected included demographic characteristics, marijuana consumption (active use, former use (last use 6 weeks prior to surgery), or never user), preoperative comorbidities, tobacco usage, operative characteristics, and postoperative complication data within 90 days.

RESULTS

A total of 815 patients were included, with 61 patients (7.5%) reporting active marijuana use, 31 patients (3.8%) reporting former marijuana use, and 723 (88.7%) reporting never using marijuana. The average age was 45.32 (SD 11.31), and the average BMI was 29.85 (SD 4.44). At the time of surgery, patients with any history of marijuana use had an increased risk of complications (OR=1.96; p = 0.006), and active marijuana users had a significantly higher risk of hematoma formation (OR = 3.02; p = 0.013).

CONCLUSIONS

Active marijuana use was significantly associated with an increased risk of postoperative hematoma formation following abdominal body contouring surgeries. These findings suggest the need for routine preoperative screening and tailored risk-reduction strategies for marijuana users.

LEVEL OF EVIDENCE III

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The Impact of Marijuana Use on Postoperative Outcomes in Abdominal-based Free Flap Breast Reconstruction

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 (VTE) 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

 A total of 162 patients were included and 13 patients (8.5%) had reported marijuana use on presurgical 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 VTE (15 vs. 1%; odds ratio (OR) 13.4 [95% confidence interval (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, reoperation, postoperative 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 vs. 49 ± 45 MME; p = 0.0003), although they had similar lengths of stay, achievement of mobilization on post operative day (POD)1, and maximal pain scores.

CONCLUSION

 Marijuana use increases the risks of postoperative VTE 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.

Marijuana and Vascular Disease: A Review

Marijuana use is common and increasing due to decriminalization, legalization, and expansion of medical use. As a result, the proportion of vascular patients with marijuana is also expected to increase, raising questions if cannabis use affects the incidence and outcomes of vascular disease. Active ingredients of cannabis have been shown to interact with receptors found on vascular endothelium, promoting oxidative stress and endothelial dysfunction. However, current clinical studies have yet to demonstrate a relationship between marijuana use and atherosclerosis. Nonetheless, cannabis arteritis is a rare condition where cannabis is hypothesized to induce vascular inflammation. Future research with high-quality studies is needed to clarify the impact of marijuana use on vascular diseases.