Association Between Cannabis Use and Opioid Consumption, Pain, and Respiratory Complications After Surgery: A Retrospective Cohort Analysis

Elyad Ekrami; Sinem Sari; Orkun Kopac; Dong Wang; Edward J Mascha; Samantha Stamper; Wael Ali Sakr Esa; Harsha Nair; Kurt Ruetzler; Alparslan Turan

doi:10.1213/ANE.0000000000006785

Association Between Cannabis Use and Opioid Consumption, Pain, and Respiratory Complications After Surgery: A Retrospective Cohort Analysis

Anesth Analg. 2024 Jan 8. doi: 10.1213/ANE.0000000000006785. Online ahead of print.

Authors

Elyad Ekrami¹, Sinem Sari^{1

2}, Orkun Kopac¹, Dong Wang^{1

3}, Edward J Mascha^{1

3}, Samantha Stamper⁴, Wael Ali Sakr Esa^{1

4}, Harsha Nair⁴, Kurt Ruetzler^{1

4}, Alparslan Turan^{1

4}

Affiliations

¹ From the Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.
² Department of General Anesthesiology, Adnan Menderes University, Aydin, Turkey.
³ Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio; and.
⁴ Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, Ohio.

PMID: 38190341
DOI: 10.1213/ANE.0000000000006785

Abstract

Background: Cannabis is a widely used illicit drug with effects on different pain pathways. However, interactions between cannabis and postoperative pain are unclear. Cannabis smoking also affects the lungs, but the impact of cannabis use on postoperative pulmonary complications is unknown. We hypothesized that preoperative cannabis use in adults having elective surgery is associated with higher postoperative opioid consumption. Secondarily, we tested the hypothesis that cannabis use is associated with higher pain scores, hypoxemia (oxygen saturation [Spo2]/fraction of inspired oxygen [Fio2] ratio), and higher postoperative pulmonary complications compared to nonuse of cannabis.

Methods: In this retrospective study, we included adult patients who had elective surgeries at Cleveland Clinic Main Campus between January 2010 and December 2020. The exposure was use of cannabis within 30 days before surgery, and the control group never used cannabis. Patients who had regional anesthesia or chronic pain diagnosis were excluded. The primary outcome was postoperative opioid consumption; 3 secondary outcomes were time-weighted average (TWA) postoperative pain score, TWA Spo2/Fio2 ratio, and composite of pulmonary complications after surgery. We assessed the association between cannabis use and opioid consumption during the first 24 postoperative hours using linear regression on log-transformed opioid consumption with a propensity score-based method (inverse probability of treatment weighting [IPTW]) adjusting for confounders. We further adjusted for imbalanced confounding variables after IPTW was applied.

Results: In total, 1683 of 34,521 patients were identified as cannabis users. Cannabis use was associated with increased opioid consumption, with an adjusted ratio of geometric means (95% confidence interval [CI]) of 1.30 (1.22-1.38; P < .0001) for cannabis users versus nonusers. Secondarily, (1) cannabis use was associated with increased TWA pain score, with a difference in means of 0.57 (95% CI, 0.46-0.67; P < .0001); (2) cannabis use was not associated with TWA Spo2/Fio2, with an adjusted difference in means of 0.5 (95% CI, -3.1 to 4.2; P = .76); and (3) cannabis use was not associated with a collapsed composite of pulmonary complications, with estimated odds ratio of 0.90 (95% CI, 0.71-1.13; P = .34).

Conclusions: Adult cannabis users undergoing surgeries were found to have significantly higher postoperative opioid consumption and pain scores than nonusers. Cannabis use did not have a clinically meaningful association with hypoxia or composite pulmonary complications.