Cannabis use disorder linked with higher complication rates after TKA
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SAN DIEGO — Patients with cannabis use disorder experienced longer length of stay, higher rates of 90-day medical complications and costs of care after total knee arthroplasty vs. a comparison cohort, according to results presented here.
Rushabh M. Vakharia, MD, and colleagues used a private payer database to identify all patients with a history of cannabis use disorder who underwent TKA for end-stage osteoarthritis from Jan. 1, 2008 to Dec. 31, 2018. Researchers randomly matched patients with cannabis use disorder to a comparison cohort based on age, sex, coronary artery disease, diabetes mellitus, hyperlipidemia, hypertension and obesity.
“We looked at dependent variables, which were length of stay, medical complications at the 90-day interval, 2-year prostheses-related complications and the cost of care in the bundle era for 90 days,” Vakharia, of Maimonides Medical Center, told Healio Orthopedics about research presented at the American Academy of Orthopaedic Surgeons Annual Meeting.
Results showed patients with cannabis use disorder had a significantly longer in-hospital length of stay, as well as a significantly higher frequency and odds of 90-day medical complications, compared with the comparison cohort. Vakharia noted patients with cannabis use disorder had higher rates of cardiopulmonary-related complications, respiratory failures and thromboembolic complications.
“What was interesting was the fact that the prostheses-related complications were also significantly higher,” Vakharia said. “Currently, there is no basic science data to explain why this would occur. We would need some larger prospective studies to explain this.”
Researchers also found significantly higher day-of-surgery and 90-day episode of care costs among patients with cannabis use disorder.
Vakharia noted orthopedic surgeons should take a multidisciplinary approach in caring for patients with cannabis use disorder undergoing TKA for OA to optimize patients prior to surgery and identify reasons they are using cannabis.
“Most people that are using cannabis generally have other comorbid conditions, such as underlying depression or anxiety or even severe pain that they are using [cannabis] to mitigate that pain that they might be having from back problems or any other health condition,” Vakharia said. “I think identifying the root cause as to why these patients are using it can potentially help to mitigate many of the adverse events found in this study.”
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Vakharia R, et al. Poster 0113. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting. Aug. 31-Sept. 3, 2021; San Diego.
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