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A Budding Concern: Cannabis Use Linked To Higher Postoperative Opioid Consumption In Plastic Surgery
Theresa K. Webster, MD,
Nancy Qin, BA, Anna M. Vaeth, BS, Lucy Wei, BS, Makayla Koshheiser, BA, Parhesh Kumar, BS, Ethan Romero, BS, Leslie Cohen, MD, David M. Otterburn, MD.
Weill Cornell Medical College, New York, NY, USA.
PURPOSE:
Cannabis use has increased drastically since recreational cannabis was legalized in New York in 2021. This study evaluates how cannabis use affects postoperative opioid consumption in patients undergoing mastectomy and alloplastic reconstruction.
METHODS:
Patients who underwent mastectomy with tissue expander (TE) reconstruction between 2019-2024 were identified. Patients were classified as either cannabis-users or non-users. Postoperative opioid and acetaminophen use, along with discharge opioid quantities and refill rates, were assessed. Linear regression was used to evaluated risk factors for higher opioid consumption.
RESULTS:
The study included 35 cannabis-users and 179 non-users. Cannabis-users were significantly more likely to be African American (15.6% vs. 4.5%) and have hypertension (22.9% vs. 10.6%). Alcohol and tobacco use were also more common among cannabis-users, trending toward significance. Age, body mass index, intraoperative factors (TE plane-placement, axillary biopsy/dissection, mastectomy type), and length of hospitalization were otherwise comparable.
Postoperatively, cannabis-users had significantly higher opioid consumption at 0-12 hours (22.8 vs. 14.9 MME), 12-24 hours (20.1 vs. 14.7 MME), and in total (61.1 vs. 38.6 MME) (p < 0.05). Conversely, acetaminophen consumption was lower among cannabis-users but did not reach statistical significance. Univariable and multivariable linear regression revealed younger age (β=0.58), cannabis use (β=19.05), and longer length of hospitalization (β=2.43) to be significantly associated with increased opioid use (p<0.01, Rē=0.72). While discharge opioid quantities were similar, cannabis-users requested significantly more refills (40% vs. 23.5%, p=0.05).
CONCLUSION:
Our study suggests that perioperative cannabis use may be associated with increased opioid consumption following mastectomy and TE reconstruction.
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