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Marijuana Use and Complication Risk After Tibia Shaft Fracture Fixation
Ridge Maxson1,2, Sarah Rapaport1, Oscar Covarrubias1
1Division of Trauma, Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD; and.
Objectives:
The aim of this study was to investigate the relationship between preoperative marijuana use and complications after tibia shaft fracture fixation.
Design:
Retrospective cohort study.
Setting:
Two academic Level I trauma centers.
Patient Selection Criteria:
Adults age ≥18 years who underwent tibia shaft fracture (OTA/AO 42) fixation from 2014 to 2022 and had a minimum 3 months postoperative follow-up were included. Patients were considered marijuana users if they had current self-reported marijuana use or a urine toxicology screen positive for cannabinoids documented at initial presentation.
Outcome Measures And Comparisons:
Bivariate statistics and multivariate regression were used to evaluate the effect of marijuana use on 90-day postoperative thromboembolic and surgical complications, unplanned readmissions, and emergency department visits. Complications related to fracture union were evaluated in patients with ≥6 months follow-up. Multivariate analysis controlled for tobacco use, open fracture, and American Society of Anesthesiologist class ≥3.
Results:
Among 388 patients included in the study, the mean age was 37.6 years (range, 18-90), and most patients were men (66.5%). Ninety-six patients (25%) were identified as marijuana users. Marijuana users were significantly younger (30.5 years vs. 40 years, P < 0.001) and more likely to be men (79% vs. 62%, P = 0.002) and use tobacco currently (73% vs. 31%, P < 0.001) than nonusers. Marijuana users experienced higher rates of 90-day surgical complications (11.5% vs. 4.8%, P = 0.030) and deep infection (8.3% vs. 2.1%, P = 0.008) than nonusers. No significant difference was observed between groups in the rates of thromboembolic complications, nonunion, or delayed union ( P > 0.05). On multivariate analysis, marijuana use was not associated with odds of developing any 90-day surgical complication (odds ratios 2.01; 95% confidence intervals 0.83-4.84) or deep infection (odds ratios 2.97; 95% confidence interval 0.95-9.25).
Conclusions:
Preoperative marijuana use was not found to be associated with risk of thromboembolic, surgical, or fracture union-related complications in patients undergoing tibia shaft fracture fixation.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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