Department of Anesthesiology, University of Michigan, Ann Arbor, MI.
Opioid Prescribing Engagement Network, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
Ann Surg. 2024 Mar 1;279(3):437-442. doi: 10.1097/SLA.0000000000006085. Epub 2023 Aug 28.
To compare outcomes of patients using versus not using cannabis as a treatment for pain after discharge from surgery.
Cannabis is increasingly available and is often taken by patients to relieve pain. However, it is unclear whether cannabis use for pain after surgery impacts opioid consumption and postoperative outcomes.
Using Michigan Surgical Quality Collaborative registry data at 69 hospitals, we analyzed a cohort of patients undergoing 16 procedure types between January 1, 2021, and October 31, 2021. The key exposure was cannabis use for pain after surgery. Outcomes included postdischarge opioid consumption (primary) and patient-reported outcomes of pain, satisfaction, quality of life, and regret to undergo surgery (secondary).
Of 11,314 included patients (58% females, mean age: 55.1 years), 581 (5.1%) reported using cannabis to treat pain after surgery. In adjusted models, patients who used cannabis consumed an additional 1.0 (95% CI: 0.4-1.5) opioid pills after surgery. Patients who used cannabis were more likely to report moderate-to-severe surgical site pain at 1 week (adjusted odds ratio: 1.7, 95% CIL 1.4-2.1) and 1 month (adjusted odds ratio: 2.1, 95% CI: 1.7-2.7) after surgery. Patients who used cannabis were less likely to endorse high satisfaction (72.1% vs 82.6%), best quality of life (46.7% vs 63.0%), and no regret (87.6% vs 92.7%) (all P < 0.001).
Patient-reported cannabis use, to treat postoperative pain, was associated with increased opioid consumption after discharge from surgery that was of clinically insignificant amounts, but worse pain and other postoperative patient-reported outcomes.
比较手术后出院时使用大麻和不使用大麻治疗疼痛的患者结局。
大麻的可及性越来越高，许多患者常将其用于缓解疼痛。然而，大麻治疗术后疼痛是否会影响阿片类药物的使用和术后结局尚不清楚。
利用密歇根州外科质量协作研究注册数据，我们分析了 2021 年 1 月 1 日至 2021 年 10 月 31 日期间在 69 家医院接受 16 种手术类型的患者队列。主要暴露因素为术后使用大麻治疗疼痛。结局包括出院后阿片类药物使用（主要结局）以及患者报告的疼痛、满意度、生活质量和对手术的后悔程度（次要结局）。
在纳入的 11314 例患者中（58%为女性，平均年龄为 55.1 岁），有 581 例（5.1%）报告术后使用大麻治疗疼痛。在调整后的模型中，使用大麻的患者术后额外服用 1.0 片（95%CI：0.4-1.5）阿片类药物。使用大麻的患者在术后 1 周（调整后的优势比：1.7，95%CI：1.4-2.1）和 1 个月（调整后的优势比：2.1，95%CI：1.7-2.7）时更有可能报告手术部位中度至重度疼痛。使用大麻的患者更不可能表示非常满意（72.1% vs 82.6%）、生活质量最佳（46.7% vs 63.0%）和无遗憾（87.6% vs 92.7%）（均 P<0.001）。
患者报告的术后使用大麻治疗疼痛与出院后阿片类药物的使用增加有关，尽管增加的量具有临床意义，但疼痛加剧和其他术后患者报告的结局更差。
