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Perioperative cannabis use: a longitudinal study of associated clinical characteristics and surgical outcomes
  1. Jenna McAfee1,
  2. Kevin F Boehnke1,
  3. Stephanie M Moser1,
  4. Chad M Brummett1,
  5. Jennifer F Waljee2 and
  6. Erin E Bonar3,4
  1. 1 Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan, USA
  2. 2 Department of Surgery, University of Michigan, Ann Arbor, Michigan, USA
  3. 3 Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
  4. 4 Injury Prevention Center, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Jenna McAfee, Anesthesiology, University of Michigan, Ann Arbor, MI 48108, USA; jennagoe{at}


Background Despite increases in cannabis use generally and for pain management, data regarding cannabis use in patients undergoing surgery are lacking. This study examined the prevalence of cannabis use among patients undergoing elective surgery and explored differences in clinical characteristics and surgical outcomes between cannabis users and non-cannabis users.

Methods This prospective study included 1335 adults undergoing elective surgery. Participants completed self-report questionnaires preoperative and at 3-month and 6-month postsurgery to assess clinical characteristics and surgical outcomes.

Results Overall, 5.9% (n=79) of patients reported cannabis use (53.2% medical, 19.0% recreational and 25.3% medical and recreational). On the day of surgery, cannabis users reported worse pain, more centralized pain symptoms, greater functional impairment, higher fatigue, greater sleep disturbances and more symptoms of anxiety and depression versus non-cannabis users (all p<0.01). Additionally, a larger proportion of cannabis users reported opioid (27.9%) and benzodiazepine use (19.0%) compared with non-cannabis users (17.5% and 9.2%, respectively). At 3 and 6 months, cannabis users continued to report worse clinical symptoms; however, both groups showed improvement across most domains (p≤0.05). At 6 months, the groups did not differ on surgical outcomes, including surgical site pain (p=0.93) or treatment efficacy (p=0.88).

Conclusions Cannabis use is relatively low in this surgical population, yet cannabis users have higher clinical pain, poorer scores on quality of life indicators, and higher opioid use before and after surgery. Cannabis users reported similar surgical outcomes, suggesting that cannabis use did not impede recovery.

  • pain management
  • outcomes
  • pain
  • postoperative

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  • Contributors All authors critically evaluated the final draft of the manuscript and approve its submission to this journal. JM was responsible for the overall scientific direction in the conception of the study, including planning the data analyses and subsequent interpretation of data, and wrote the first draft of the manuscript. KB was also involved in the planning of the study, including selection of the cannabis survey items, as well as providing substantial input on the first draft of the manuscript and subsequent revisions. SM performed all data analyses as well as writing the analyses and results section of the manuscript. CMB is the principal investigator of the AOS registry from which data were obtained and was responsible for the overall scientific direction and data acquisition, as well as providing feedback on analyses and editing the manuscript. JFW provided valuable input on the interpretation of the data, including suggesting additional analyses most relevant to surgeons, as well as contributing to the manuscript drafts. EB provided important scientific content as well interpretation of the data and revising the manuscript critically.

  • Funding The study was funded by the following NIH grants: NIAMS R01AR060392 (MPI Clauw and Brummett), NIDA R01DA038261 (MPI Clauw and Brummett) and NIDA R01DA042859 (MPI Waljee and Brummett). Additional funding was provided by the Department of Anesthesiology, the Medical School Dean’s Office and the Michigan Genomics Initiative of the University of Michigan (Ann Arbor, Michigan, USA).

  • Competing interests CMB is a consultant for Heron Therapeutics (San Diego, California, USA), not related to this work. KB sits on a data safety and monitoring committee (unpaid) for an ongoing study with Vireo Health (New York, New York, USA).

  • Patient consent for publication Not required.

  • Ethics approval Data collection and subsequent analyzes were approved by the Institutional Review Board at the University of Michigan (Ann Arbor, Michigan, USA).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.