Self reported cannabis use is rapidly increasing in North America, particularly following legalization in several states in the United States and Canada, with use rates approaching those of tobacco. Despite the increasing frequency of use among patients, there is a paucity of data on the influence of cannabis on shoulder arthroscopy, particularly with regard to complications. Furthermore, the relationship between cannabis use and postoperative opioid use remains poorly understood in this population. We hypothesized that complication rates, postoperative opioid use, and cost does not differ between patients with and without cannabis use.
Data was collected from a large commercial insurance database (PearlDiver, USA) between the years 2010-2019. Patients who underwent shoulder arthroscopy with reported cannabis use were identified using Common Procedural Terminology (CPT) codes and the appropriate International Classification of Diseases (ICD) codes. This group was then matched by age, procedure, gender, Charleston Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), obesity, tobacco use, diabetes to a group of similar patients without self-reported cannabis use. Opioid use over the episode of care, evaluated by morphine milligram equivalents (MME), and 30-day cost were compared between groups using unequal variance t-test. Complication rates between groups were examined using odd’s ratio (OR).
A total of 5174 patients (67% male and 33% female) were included in the cannabis use and no cannabis use groups, respectively. Patients with reported cannabis use received significantly fewer postoperative opioids on average (1877 +/- 2971 MME) than those without cannabis use (2363 +/- 4584 MME) (p<0.001). Cannabis use patients had significantly fewer total cerebrovascular accidents (CVA) (OR=0.3635, p<0.001), deep vein thrombosis (DVT) (OR 0.6460, p<0.001), and pulmonary emboli (OR 0.3488, p<0.001). Furthermore, cannabis users experienced significantly fewer DVT at 30 days (OR 0.5815, p=0.023) and 90 days (OR 0.6600, p=0.024) and PE at 30 days (OR 0.3990, p=0.014) and 90 days (OR 0.3426, p=0.002). There were no significant differences in wound complications, dehiscence, surgical site infections, mechanical complications, nerve injury, sepsis, transfusions, pneumonia, cardiac arrest, hematoma, or myocardial infarction between groups. Patients who use cannabis have a significantly higher 30-day cost after shoulder arthroscopy ($2004.78 +/- $2970.66) than those who do not report use ($1704.67 +/- 2334.78) (p < 0.001).
Patients using cannabis use fewer opioids following shoulder arthroscopy. Additionally, cannabis use is not a risk for postoperative complications, and cannabis users have a lower risk of CVA, PE, and DVT. However, cannabis use is associated with a higher 30-day cost after these procedures.