Marijuana use and mortality following orthopedic surgical procedures

ABSTRACT

Background: The association between marijuana use and surgical procedures is a matter of increasing societal relevance that has not been well studied in the literature. The primary aim of this study is to evaluate the relationship between marijuana use and in-hospital mortality, as well as to assess associated comorbidities in patients undergoing commonly billed orthopedic surgeries. Methods: The National Inpatient Sample (NIS) database from 2010 to 2014 was used to determine the odds ratios for the associations between marijuana use and in-hospital mortality, heart failure (HF), stroke, and cardiac disease (CD) in patients undergoing 5 common orthopedic procedures: total hip (THA), total knee (TKA), and total shoulder (TSA) arthroplasties, spinal fusion, and traumatic femur fracture fixation. Results: Of 9,561,963 patients who underwent one of the 5 selected procedures in the 4-year period, 26,416 (0.28%) were identified with a diagnosis of marijuana use disorder. In hip and knee arthroplasty patients, marijuana use was associated with decreased odds of mortality compared with no marijuana use (P < .0001) and increased odds of HF (P = .018), stroke (P = .0068), and CD (P = .0123). Traumatic femur fixation patients had the highest prevalence of marijuana use (0.70%), which was associated with decreased odds of mortality (P = .0483), HF (P = .0076), and CD (P = .0003). For spinal fusions, marijuana use was associated with increased odds of stroke (P < .0001) and CD (P < .0001). Marijuana use in patients undergoing total shoulder arthroplasty was associated with decreased odds of mortality (P < .001) and stroke (P < .001). Conclusions: In this study, marijuana use was associated with decreased mortality in patients undergoing THA, TKA, TSA, and traumatic femur fixation, although the significance of these findings remains unclear. More research is needed to provide insight into these associations in a growing surgical population.

KEYWORDS:

• Arthroplasty
• cannabis
• comorbidities
• marijuana
• mortality
• orthopedics
• surgery

Author contributions

Each author has significantly contributed to the article, including material participation in the research and/or article preparation. Each author has contributed substantially to the (1) conception and design of the study, or acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be submitted. All authors have seen and approved the final article.

A.S.M. was involved in the design, analysis and interpretation of the data, drafting the article, revision of article, and preparation of the final manuscript for submission. W.S. was involved in the conception, design, analysis and interpretation of the data, drafting the article, and revision of the article. S.M. was involved with the data acquisition and drafting the article. B.A.P. was involved with the conception and design of the study, analysis and interpretation of data, and revision of the article. G.G. was involved with the data acquisition, analysis and interpretation of the data, and revision of article. A.S. was involved with the conception and design of the study and revision of the article. S.M.N. was involved with the conception and design of the study, analysis and interpretation of the data, and revision of the article.