Preoperative Cannabis Use and Ankle ORIF Outcomes: Higher Risks of Infection, Nonunion, and Reoperation

Area of Science:

• Orthopaedic Surgery
• Perioperative Medicine
• Cannabis Research

Background:

• Cannabis use is increasing, necessitating understanding its perioperative impact.
• Orthopaedic research has explored cannabis risks, but ankle fracture fixation outcomes remain unexamined.
• Clarifying these risks is crucial for managing ankle fracture patients.

Purpose of the Study:

• To investigate the association between preoperative cannabis use and perioperative outcomes following surgical ankle fracture fixation.
• To identify specific complications and health care utilization patterns in cannabis users compared to non-users.

Main Methods:

• Retrospective cohort analysis of patients undergoing open reduction and internal fixation (ORIF) for ankle fractures.
• Propensity score matching (PSM) controlled for 27 confounders, comparing active cannabis users with non-users.
• Outcomes assessed included medical, surgical, and healthcare utilization complications up to 3 years postoperatively.

Main Results:

• Cannabis use was linked to higher risks of infection, wound dehiscence, and readmission at 90 days.
• Persistent associations at 6 months included increased risks of infection, sepsis, and hardware infection.
• At 3 years, cannabis use correlated with significantly higher risks of nonunion and reoperation.

Conclusions:

• Preoperative cannabis use is associated with substantially increased complications after ankle ORIF.
• Findings suggest cannabis use is a modifiable perioperative risk factor, similar to tobacco use.
• Targeted patient counseling and risk-reduction strategies are essential for optimizing outcomes.