Ahrens Elena, Wachtendorf Luca J, Chiarella Laetitia S, Ashrafian Sarah, Suleiman Aiman, Tartler Tim M, Azizi Basit A, Chen Guanqing, Berger Amnon A, Shay Denys, Teja Bijan, Banner-Goodspeed Valerie, Ma Haobo, Eikermann Matthias, Hill Kevin P, Schaefer Maximilian S
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
Center for Anesthesia Research Excellence (CARE), Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
EClinicalMedicine. 2023 Jan 31;57:101831. doi: 10.1016/j.eclinm.2023.101831. eCollection 2023 Mar.
There is paucity of data regarding prevalence and key harms of non-medical cannabis use in surgical patients. We investigated whether cannabis use in patients undergoing surgery or interventional procedures patients was associated with a higher degree of post-procedural healthcare utilisation.
210,639 adults undergoing non-cardiac surgery between January 2008 and June 2020 at an academic healthcare network in Massachusetts, USA, were included. The primary exposure was use of cannabis, differentiated by reported ongoing non-medical use, self-identified during structured, preoperative nursing/physician interviews, or diagnosis of cannabis use disorder based on International Classification of Diseases, 9th/10th Revision, diagnostic codes. The main outcome measure was the requirement of advanced post-procedural healthcare utilisation (unplanned intensive care unit admission, hospital re-admission or non-home discharge).
16,211 patients (7.7%) were identified as cannabis users. The prevalence of cannabis use increased from 4.9% in 2008 to 14.3% by 2020 (p < 0.001). Patients who consumed cannabis had higher rates of psychiatric comorbidities (25.3 versus 16.8%; p < 0.001) and concomitant non-tobacco substance abuse (30.2 versus 7.0%; p < 0.001). Compared to non-users, patients with a diagnosis of cannabis use disorder had higher odds of requiring advanced post-procedural healthcare utilisation after adjusting for patient characteristics, concomitant substance use and socioeconomic factors (aOR [adjusted odds ratio] 1.16; 95% CI 1.02-1.32). By contrast, patients with ongoing non-medical cannabis use had lower odds of advanced post-procedural healthcare utilisation (aOR 0.87; 95% CI 0.81-0.92, compared to non-users).
One in seven patients undergoing surgery or interventional procedures in 2020 reported cannabis consumption. Differential effects on post-procedural healthcare utilisation were observed between patients with non-medical cannabis use and cannabis use disorder.
This work was supported by an unrestricted philantropic grant from Jeff and Judy Buzen to Maximilian S. Schaefer.
关于外科手术患者中非医疗用途大麻使用的患病率和主要危害的数据较少。我们调查了接受手术或介入手术的患者使用大麻是否与术后更高程度的医疗保健利用相关。
纳入了2008年1月至2020年6月期间在美国马萨诸塞州一个学术医疗网络接受非心脏手术的210,639名成年人。主要暴露因素是大麻的使用，根据结构化术前护理/医生访谈中报告的持续非医疗用途、自我认定情况，或基于国际疾病分类第9版/第10版诊断代码诊断的大麻使用障碍进行区分。主要结局指标是术后高级医疗保健利用的需求（计划外重症监护病房入院、再次住院或非家庭出院）。
16,211名患者（7.7%）被确定为大麻使用者。大麻使用的患病率从2008年的4.9%上升到2020年的14.3%（p<0.001）。使用大麻的患者有更高的精神疾病合并症发生率（25.3%对16.8%；p<0.001）和伴随的非烟草物质滥用发生率（30.2%对7.0%；p<0.001）。与非使用者相比，在调整患者特征、伴随物质使用和社会经济因素后，被诊断为大麻使用障碍的患者术后需要高级医疗保健利用的几率更高（调整后的优势比[aOR]为1.16；95%置信区间[CI]为1.02 - 1.32）。相比之下，持续非医疗用途大麻使用者术后高级医疗保健利用的几率较低（与非使用者相比，aOR为0.87；95%CI为0.81 - 0.92）。
2020年，接受手术或介入手术的患者中有七分之一报告使用过大麻。在非医疗用途大麻使用者和大麻使用障碍患者之间观察到了对术后医疗保健利用的不同影响。
这项工作得到了杰夫和朱迪·布曾给马克西米利安·S·舍费尔的无限制慈善赠款的支持。
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