Patients undergoing certain major operations may be in line for a shorter length of recovery – if they have a history of cannabis use.
That is according to a new study published last month in the journal Arthroplasty. The research centered on patients who have undergone total joint arthroplasty (TJA), or an operation where the individual has their hip or knee replaced.
According to the authors of the study, patients with a history of “cannabis use disorder,” or “CUD,” “had significantly shorter length of stay (LOS) and higher rates of home discharge following primary TJA compared to the control group.”
As the authors pointed out, the shifting laws and attitudes in the United States toward cannabis use has forced a reckoning for the medical community in how they manage treatment for their patients. The growing “legalization and decriminalization of cannabis across the United States has been associated with a considerable rise in self-reported cannabis use amongst surgical patients, including those undergoing total joint arthroplasty,” they wrote. Although “cannabis is primarily used for recreational purposes,” they said, “cannabinoid metabolites have shown analgesic and anti-inflammatory properties and have thus been proposed as an alternative to opioids in the management of acute and chronic pain.”
And while “cannabis use may conceivably be beneficial in the postoperative setting, cannabis use disorder (CUD), defined in part as a problematic pattern of cannabis use leading to clinically significant impairment or distress, has been correlated with increased postoperative pain and opioid use following orthopedic surgical procedures.”
“Progressive legalization of cannabis use makes it increasingly important for clinicians to understand the characteristics of this evolving patient population. As this growing population continues to evolve, understanding their comorbidities, behavioral characteristics, and postoperative clinical and economic outcomes allow orthopedic surgeons and the multidisciplinary healthcare teams to better tailor their care and management of these patients,” the authors wrote.
Taken together, the authors said that means that subsequent research “should aim to more closely and comparatively assess the demographic profile of patients with both recreational use and substance use disorder, along with potential barriers in their access to medical care.”
“This understanding should be associated with the expansion and improvement of public health initiatives and the development of frameworks to better deliver substance use screenings and interventions to this patient population. Such initiatives, combined with the development of standardized perioperative protocols, have the potential to optimize postsurgical and overall health outcomes in this at-risk patient population,” the authors wrote.
The authors did, however, offer up some caveats, noting that the “study is limited for several reasons.”
For example, they pointed out that patients with cannabis use disorder “would be incentivized to leave the hospital as soon as possible and return home to continue use of cannabis and potentially other substances.”
“Because such use may be associated with problematic behavioral changes and abandonment of social, occupational, or recreational activities, these patients may be at risk for worse postoperative and overall health outcomes in the postoperative, post-discharge period. In contrast, the preoperative and in-hospital period, during which a multidisciplinary team has full access to care for these patients, can thus serve as an opportune time for comprehensive social and medical intervention. As such, orthopedic surgeons and the multidisciplinary medical and social service team should remain aware of the risks these patients face, and perioperative interventions should be considered to optimize both long-term outcomes and general health improvement in these patients,” they wrote.
As NORML noted, other “studies have reported contrary findings, including a paper recently published in The Lancet which determined that patients diagnosed [with] cannabis use disorder more often required advanced post-procedural health care than did those with no recent history of use.”
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