cannabis marijuana

Cannabis Use Disorder Linked to Higher Costs and More Complications After Surgery Interview with:

Paul Potnuru, MDAssistant Professor Anesthesiology, Critical Care and Pain Medicine The John P. and Kathrine G. McGovern Medical School The University of Texas Health Science Center at Houston

Dr. Potnuru

Paul Potnuru, MD
Assistant Professor
Anesthesiology, Critical Care and Pain Medicine
The John P. and Kathrine G. McGovern Medical School
The University of Texas Health Science Center at Houston
UTHealth What is the background for this study?

Response: The use of cannabis is on the rise in the United States, as it becomes increasingly legally accepted and is viewed as harmless. Furthermore, the potency of cannabis is steadily increasing over time.

There is some evidence from previous studies that compared to non-users, cannabis users require more anesthetics, have higher pain after surgery that requires more opioids, and have an increased risk of postoperative nausea and vomiting.

Given this context of increased usage and potential risks during surgery, we conducted a study to examine the impact of cannabis use on patients undergoing surgery. What are the main findings?

Response:  We used a nationally-representative dataset (National Inpatient Sample) to study major elective surgeries performed in the United States from 2016-2019. We compared major complication rates of patients with cannabis use disorder (to those without the disorder). Major complications included things like heart attacks, strokes, blood clots, and infections.

Our research revealed that individuals with cannabis use disorder have a roughly 20% higher chance (relatively) of experiencing major complications. In comparison to the 6.6% complication rate in non-users, those with cannabis use disorder had a 7.7% complication rate. To give some perspective, the additional 1% complication rate is comparable to the risk that tobacco smokers face during surgery (4.5% vs. 3.7%).

Research has shown that cannabis use can result in health issues through specific pathways and mechanisms. For instance, it can trigger spasms in blood vessels, increasing the risk of heart attacks and strokes. Additionally, cannabis has immunosuppressant properties, which can benefit patients with autoimmune conditions but may also lead to greater infection rates during surgery. So our study’s clinical findings of higher complication rates like heart attacks, strokes, and infections in surgical patients are supported by previous studies that predicted these effects.

A last and particularly interesting finding was that patients with cannabis use disorder who underwent surgery stayed in the hospital for the same amount of time as non-users (about two days), but their hospitalization costs were 6% higher. This indicates that the higher rate of complications among cannabis users had a real impact on the resources needed for their post-surgery care. What should readers take away from your report?

Response: So the main finding of our study is that cannabis overuse can be harmful to patient health during and after surgery.

Our findings strongly support recent ASRA guideline recommendations that patients should discuss any cannabis use with their doctors before surgery including the type, amount, and frequency of cannabis consumption. This discussion will help patients understand the risks and benefits of cannabis use so they can make informed health decisions. What recommendations do you have for future research as a results of this study?

Response: Future research should focus on quantifying cannabis use by type, route, dose, and frequency to determine more accurate associations with health risks. This will help more clearly delineate the thresholds for cannabis “overuse” in different contexts.

Disclosures: No disclosures to report. This study was investigator-initiated and independently performed without any external funding/support.


Potnuru PP, Jonna S, Williams GW. Cannabis Use Disorder and Perioperative Complications. JAMA Surg. Published online July 05, 2023. doi:10.1001/jamasurg.2023.2403

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Last Updated on July 10, 2023 by Marie Benz