Impact Of Marijuana Use On Vascular Surgery Outcomes
Drew J. Braet, M.D., Jeremy Albright, Nicholas H. Osborne, M.D., Craig Brown, M.D., Peter K. Henke, M.D..
University of Michigan, Ann Arbor, MI, USA.
Objectives: Marijuana is one of the most commonly used substances in the US, with national use on the rise. However, there is a paucity of data regarding the effects of marijuana and surgical outcomes. The aim of this study was to assess the effect of marijuana use on post-operative outcomes after vascular surgery procedures.
Methods: We queried a large statewide registry from 2014 to 2021 to assess patients who underwent carotid endarterectomy (CEA), carotid artery stenting (CAS), endovascular aneurysm repair (EVAR), open abdominal aortic aneurysm (AAA) repair, open bypass, and peripheral vascular interventions (PVI). Data was gathered regarding marijuana use and the association with post-operative outcomes at 30 days and 1 year.
Results: 82274 patients were identified. 16,857 (20.49%) underwent CEA, 4786 (5.82%) underwent CAS, 7715 (9.38%) underwent EVAR, 1470 (1.79%) underwent open AAA repair, 12567 (15.27%) underwent open bypass, and 38879 (47.26%) underwent PVI. 78,229 (95.12%) reported no marijuana use while 4,045 (4.88%) reported marijuana use in the past month. Patients who reported marijuana use in the past month had a higher proportion of discharge with opioids, taking opioids at 30 days, decreased bypass patency, increased rates of amputation, and increased readmissions (Table 1). After multivariable adjustment there were no associations with marijuana use and poor outcomes after CAS. Marijuana use was associated with increased opioid use at discharge (OR: 1.53, 95% CI: 1.38-1.70) and continued opioid use post-operatively (OR: 1.18, 95% CI: 1.02-1.36) after CEA, EVAR, open AAA, open bypass, and PVI. Marijuana use was associated with increased amputation at 30 days (OR: 1.20, 95% CI: 1.06-1.35) and 1 year (OR: 1.23, 95% CI: 1.08-1.40) after EVAR, open AAA, and open bypass procedures Additionally, marijuana use was associated with decreased bypass patency at 30 days (OR: 0.62, 95% CI: 0.42-0.94) and 1 year (OR: 0.64, 95% CI 0.43-0.96) after open bypass procedures.
Conclusions: This study shows the impact of marijuana use in vascular surgical patients, including decreased graft patency, increased amputation, and increased opioid use post-operatively. Although future studies are needed, the present study provides novel data that can be used to counsel patients undergoing vascular surgery.
| Table 1. Post-operative Outcomes and Marijuana Use | ||||
| Variable | Total Sample | No Use | Used Marijuana | P Value |
| Discharged with Opioid | 11,347/28,502 (39.81%) | 10,304/26,655 (38.66%) | 1,043/1,847 (56.47 %) | < 0.001 |
| 30 Day Mortality | 1,495/72,355(2.07%) | 1,444/68,929(2.09%) | 51/3,426(1.49%) | 0.018 |
| 30 Day Readmission | 1,630/19,406(8.4%) | 1,509/17,991(8.39%) | 121/1,415(8.55%) | 0.87 |
| 30 Day MI | 868/69,032(1.26%) | 836/65,756(1.27%) | 32/3,276(0.98%) | 0.163 |
| 30 Day TIA/Stroke | 1,038/69,462(1.49%) | 985/66,177(1.49%) | 53/3,285(1.61%) | 0.615 |
| 30 Day Amputation | 8,486/45,007(18.85%) | 7,865/42,521(18.5%) | 621/2,486(24.98%) | < 0.001 |
| 30 Day RVB Patency | 4,139/4,412(93.81%) | 3,776/4,011(94.14%) | 363/401(90.52%) | 0.006 |
| 30 Day Taking Opioid | 4,211/15,399(27.35%) | 3,804/14,291(26.62%) | 407/1,108(36.73%) | < 0.001 |
| 1 Year Mortality | 2,492/29,757(8.37%) | 2,392/28,244(8.47%) | 100/1,513(6.61%) | 0.013 |
| 1 Year Readmission | 3,033/14,185(21.38%) | 2,790/13,197(21.14%) | 243/988(24.6%) | 0.012 |
| 1 Year MI | 969/27,108(3.57%) | 928/25,724(3.61%) | 41/1,384(2.96%) | 0.236 |
| 1 Year TIA/Stroke | 1,160/28,078(4.13%) | 1,104/26,664(4.14%) | 56/1,414(3.96%) | 0.793 |
| 1 Year Amputation | 9,231/18,041(51.17%) | 8,551/16,771(50.99%) | 680/1,270(53.54%) | 0.084 |
| 1 Year RVB Patency | 1,537/1,966(78.18%) | 1,418/1,795(79%) | 119/171(69.59%) | 0.006 |
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