Nationwide outcomes of cardiac surgery in patients with cannabis use disorder

OBJECTIVE: To characterize in-hospital morbidity and mortality in patients undergoing cardiovascular surgery with and without cannabis use disorder (CUD) using a national database. METHODS: Between 2016 and 2018, 846,837 patients who underwent cardiovascular surgery were identified from the Nationwide Readmissions Database. Of these, 11,724 (1.4%) with CUD were identified. A 1:1 balancing-score matching was performed to compare outcomes while controlling baseline characteristics and comorbidities. RESULTS: Concomitant substance abuse, including smoking/nicotine, opioid abuse, cocaine/stimulants abuse, and alcohol abuse, was also significantly higher (P < .001 for all). Patients with CUD had a higher prevalence of deficiency anemia, congestive heart failure, chronic lung disease, depression, drug abuse, liver disease, neurological disorder, peripheral vascular disease, psychoses, pulmonary circulatory disorders and weight loss. Prior to matching, stroke (3.4% vs. 2.8%, P = .008), pneumonia (13% vs. 9.4%, P < .001), sepsis (5.5% vs. 3.2%, P < .001), and pulmonary embolism (3.6% vs. 1.8%, P < .001) were more common among patients with CUD. However, after matching, there were no differences in overall or individual complications. Mortality among patients with CUD was lower in both unmatched (1.8% vs. 3.0%, P < .001) and matched comparisons (1.8% vs. 2.7%, P < .001). CONCLUSIONS: Cannabis abuse was not associated with additional in-hospital morbidity or mortality and may not preclude cardiovascular surgery. However, CUD is a marker for polysubstance abuse, which deserves management. RELEVANCE TO CLINICAL PRACTICE: Patients with CUD are a vulnerable population with concomitant smoking, opioid abuse, cocaine abuse, and alcohol abuse that deserves treatment while undergoing cardiovascular surgery.