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Regional anesthesia and acute pain
Cannabis use and acute postoperative pain outcomes in older adults: a propensity matched retrospective cohort study
  1. Ruba Sajdeya,
  2. Masoud Rouhizadeh,
  3. Robert L Cook,
  4. Ronald L Ison,
  5. Chen Bai,
  6. Sebastian Jugl,
  7. Hanzhi Gao,
  8. Mamoun T Mardini,
  9. Osama Dasa,
  10. Kimia Zandbiglari,
  11. Farzana I Adiba,
  12. Almut G Winterstein,
  13. Catherine C Price,
  14. Thomas A Pearson,
  15. Christoph N Seubert and
  16. Patrick J Tighe
  1. University of Florida, Gainesville, Florida, USA
  1. Correspondence to Dr Ruba Sajdeya, University of Florida, Gainesville, FL 32610, USA; rubasajdeya{at}ufl.edu

Abstract

Introduction Cannabis use is increasing among older adults, but its impact on postoperative pain outcomes remains unclear in this population. We examined the association between cannabis use and postoperative pain levels and opioid doses within 24 hours of surgery.

Methods We conducted a propensity score-matched retrospective cohort study using electronic health records data of 22 476 older surgical patients with at least 24-hour hospital stays at University of Florida Health between 2018 and 2020. Of the original cohort, 2577 patients were eligible for propensity-score matching (1:3 cannabis user: non-user). Cannabis use status was determined via natural language processing of clinical notes within 60 days of surgery and structured data. The primary outcomes were average Defense and Veterans Pain Rating Scale (DVPRS) score and total oral morphine equivalents (OME) within 24 hours of surgery.

Results 504 patients were included (126 cannabis users and 378 non-users). The median (IQR) age was 69 (65–72) years; 295 (58.53%) were male, and 442 (87.70%) were non-Hispanic white. Baseline characteristics were well balanced. Cannabis users had significantly higher average DVPRS scores (median (IQR): 4.68 (2.71–5.96) vs 3.88 (2.33, 5.17); difference=0.80; 95% confidence limit (CL), 0.19 to 1.36; p=0.01) and total OME (median (IQR): 42.50 (15.00–60.00) mg vs 30.00 (7.50–60.00) mg; difference=12.5 mg; 95% CL, 3.80 mg to 21.20 mg; p=0.02) than non-users within 24 hours of surgery.

Discussion This study showed that cannabis use in older adults was associated with increased postoperative pain levels and opioid doses.

  • Analgesics, Opioid
  • Pain, Postoperative
  • Acute Pain
  • Epidemiology

Data availability statement

Data are available on reasonable request. Data are available on a reasonable request to the corresponding author after fulfilling the University of Florida’s data security and use agreement requirements, and in accordance with the Health Insurance Portability and Accountability Act regulations to protect patient privacy.

https://doi.org/10.1136/rapm-2024-105633

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    Data availability statement

    Data are available on reasonable request. Data are available on a reasonable request to the corresponding author after fulfilling the University of Florida’s data security and use agreement requirements, and in accordance with the Health Insurance Portability and Accountability Act regulations to protect patient privacy.

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    Footnotes

    • X @RSajdeya

    • Contributors RS accepts full responsibility for the work and/or the conduct of the study, had access to the data, and controlled the decision to publish. Study concept and design: RS, PJT, RLC, TAP, AGW, MR and OD. Acquisition, analysis, or interpretation of data: RS, PJT, RLC, TAP, AGW, MR, CB, RLI, SJ, HG, MTM, OD, KZ, FIA, CCP and CNS. Drafting of the manuscript: RS, OD, PJT, RLC, TAP, AGW, MR and CNS. Critical revision of the manuscript for important intellectual content: RS, PJT, CNS, RLC, TAP, AGW, MR, OD, MTM, CCP, SJ, CB, HG, RLI, KZ and FIA. Statistical analysis: RS and HG. Obtained funding: PJT and CCP. Administrative, technical, or material support: RS, PJT, CCP, RLI, MR, CB, SJ, KZ and FIA. Study supervision: RS, PJT, RLC, TAP, AGW, MR, CNS and CCP.

    • Funding The study was supported by the National Institute on Aging/National Institute of Health under the award number R01 AG055337. Research reported in this publication was supported in part by the University of Florida Clinical and Translational Science Institute, which is supported in part by the National Institute of Health National Center for Advancing Translational Sciences under award number UL1TR001427.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.