Association of Perioperative Cannabis Use With Postoperative Opioid Consumption in Ankle Fracture Patients

The association between cannabinoid use and perioperative pain management is debated. This study evaluates differences in patient characteristics and postoperative outcomes based on self-reported perioperative cannabis use among patients undergoing ankle fracture open reduction and internal fixation (ORIF).

An IRB-approved study of 259 adults undergoing ankle fracture ORIF (January 2016-December 2022). Data on self-reported cannabis use, demographics, pain management, and postoperative complications were collected. Outcomes included pain (VAS scores), opioid prescription duration, and complication rates. Statistical analysis through chi-square or Fisher exact tests for categorical variables, t-test or Mann-Whitney U test for continuous variables, and a generalized linear model to adjust for confounding.

Of 259 patients, 79 (30.5%) reported perioperative cannabis use. Cannabis users were younger (34.20 years vs. 45.9 years, P = <0.001), predominantly male (P = 0.003), had lower educational attainment (P = 0.011), higher concurrent tobacco use (35.4% vs. 16.1%, P = <0.001), and higher DCI scores (P = 0.010). They demonstrated longer opioid use (4.51 weeks vs. 4.08 weeks, P = 0.014) but no difference in pain scores, dosage, or complications. After adjusting for smoking, sex, and age, cannabis use was not independently associated with opioid duration (Exp[B] = 0.68; 95% CI, 0.24-1.98; P = 0.484). Among cannabis users, 23 patients (29.11%) reported cannabis helpful for postoperative pain relief.

Perioperative cannabis use was not an independent predictor for postoperative complications or opioid duration. Our findings do not support cannabis as an effective standalone analgesic in this population. Additional research is warranted to assess the effect on orthopaedic trauma care.