Evaluating Acute And Long-term Chronic Pain And Quality Of Life Outcomes In Patients With Cannabis Use Disorders Undergoing Complex Reconstructive Surgery

PURPOSE: The prevalence of cannabis use has been steadily rising in recent years, especially among younger patient populations. Previous studies have shown that cannabis use disorders (CUDs) may increase opioid use after reconstructive surgery, yet long-term effects remain unclear. This study, representing one of the largest on this topic, used the TriNetX database to assess whether pre-existing CUDs influence postoperative, anesthesia-related, and long-term outcomes in patients undergoing complex reconstructive flap procedures. A secondary aim compared these complication rates to nicotine dependence. METHODS: Using TriNetX, a retrospective cohort study was performed and identified adults undergoing pedicled or free-flap procedures, categorized by pre-existing CUD or nicotine dependence. Propensity-score matching controlled for demographics, comorbidities, and for analyses of long-term outcomes, psychosocial variables, such as chronic pain, depression and opioid-related disorders. Acute outcomes included flap failure, dehiscence, hematoma, etc. within 3 months, and anesthesia-related events within 1 week. Long-term outcomes included chronic pain, analgesic prescriptions, and mental health disorders 3 months postoperatively. RESULTS: After matching, 4366 CUD flap patients were compared to 4366 non-CUD flap patients; 22,759 nicotine using flap patients were matched to 22,759 using flap patients. CUD patients had higher rates of dehiscence (p 0.01), infection (p 0.001), anesthesia-induced confusion (p 0.01), postoperative nausea (p 0.01), hypotension (p 0.05), and blood transfusion (p 0.0001). No significant differences were observed in long-term outcomes, including chronic pain, opiate prescriptions, or mood disorders (all p 0.05). By contrast, nicotine users had significantly higher rates of flap failure, dehiscence, infection (all p 0.0001), hematoma, OR return, sepsis, anesthesia complications, chronic pain, opioid disorders, and depression (all p 0.05), with lower rates of anxiety and steroid prescriptions (both p 0.0001). CONCLUSION: CUD may be associated with a small, but significant increase in the risk of early complications in patients undergoing complex reconstruction. Nevertheless, these effects are clinically modest compared to adverse outcomes associated with nicotine use, and there were no differences in long-term outcomes in patients with CUD. While cessation of cannabis prior to elective procedures may lead to small improvements in early postoperative risk, CUD should not be seen as a contraindication in appropriately selected patients. *Source: https://ps-rc.org/meeting/Program/2026/EP27.cgi*