Is Cannabis Dependence Associated with Postoperative Infections in Hand and Wrist Surgeries?

Recreational cannabis use has been increasing alongside broader legalization efforts worldwide. Despite this trend, relatively little data exist regarding the impact of cannabis dependence on postoperative complications. This knowledge gap is even more pronounced in the context of hand surgery. This study used a large, multi-institutional database to evaluate perioperative complications following soft-tissue surgical procedures of the hand and wrist in patients with documented cannabis dependence versus nondependent patients.

The TriNetX database was queried to determine the incidence of 90-day perioperative complications following soft-tissue surgical procedures involving the hand and wrist. Complications assessed included postoperative admissions, emergency department visits, superficial soft-tissue infections or wound breakdown, systemic infections, and deep surgical site infections. Propensity score matching was performed to control for potential confounding variables and odds ratios were calculated.

We identified 498,150 patients who underwent soft-tissue surgical procedures involving the hand and wrist. Among these, 5,607 patients were diagnosed with preoperative cannabis dependence, whereas 492,543 had no history of preoperative cannabis use. Matched analyses revealed increased odds for superficial wound complications/infections (OR 1.9; 95% confidence interval [CI ]1.6-2.3), postoperative admissions (OR 2.5; 95% CI 1.7-3.6), and emergency department visits (OR 1.8; 95% CI 1.6-2.0). Additionally, there were increased odds of sepsis (OR 2.3; 95% CI 1.5-3.6) and subsequent return to the operating room for deep surgical site infections (OR 2.6; 95% CI 1.6-4.6).

Patients with documented cannabis dependence demonstrated higher odds of developing wound complications following hand and wrist soft-tissue surgical procedures. This is accompanied by a higher risk of health care utilization, including readmissions and emergency department visits. Although these findings reflect an association rather than a causal relationship, cannabis dependence may serve as a useful variable in perioperative risk stratification and patient counseling.Type of study/level of evidence: Prognostic IIc.