{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T16:07:42Z","timestamp":1792253262824,"version":"4.4.0"},"reference-count":59,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"\n Importance<\/jats:title>\n Cannabis use is growing in the US and is increasingly perceived as harmless. However, the perioperative impact of cannabis use remains uncertain.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess whether cannabis use disorder is associated with increased morbidity and mortality after major elective, inpatient, noncardiac surgery.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This retrospective, population-based, matched cohort study used data from the National Inpatient Sample for adult patients aged 18 to 65 years who underwent major elective inpatient surgery (including cholecystectomy, colectomy, inguinal hernia repair, femoral hernia repair, mastectomy, lumpectomy, hip arthroplasty, knee arthroplasty, hysterectomy, spinal fusion, and vertebral discectomy) from January 2016 to December 2019. Data were analyzed from February to August 2022.<\/jats:p>\n <\/jats:sec>\n \n Exposure<\/jats:title>\n \n Cannabis use disorder, as defined by the presence of specific\n International Statistical Classification of Diseases and Related Health Problems, Tenth Revision<\/jats:italic>\n (\n ICD-10<\/jats:italic>\n ) diagnostic codes.\n <\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measures<\/jats:title>\n \n The primary composite outcome was in-hospital mortality and 7 major perioperative complications (myocardial ischemia, acute kidney injury, stroke, respiratory failure, venous thromboembolism, hospital-acquired infection, and surgical procedure\u2013related complications) based on\n ICD-10<\/jats:italic>\n discharge diagnosis codes. Propensity score matching was performed to create a 1:1 matched cohort that was well balanced with respect to covariates, which included patient comorbidities, sociodemographic factors, and procedure type.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Among 12 422 hospitalizations, a cohort of 6211 patients with cannabis use disorder (median age, 53 years [IQR, 44-59 years]; 3498 [56.32%] male) were matched with 6211 patients without cannabis use disorder for analysis. Cannabis use disorder was associated with an increased risk of perioperative morbidity and mortality compared with hospitalizations without cannabis use disorder in adjusted analysis (adjusted odds ratio, 1.19; 95% CI, 1.04-1.37;\n P<\/jats:italic>\n \u2009=\u2009.01). The outcome occurred more frequently in the group with cannabis use disorder (480 [7.73%]) compared with the unexposed group (408 [6.57%]).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n In this cohort study, cannabis use disorder was associated with a modest increased risk of perioperative morbidity and mortality after major elective, inpatient, noncardiac surgery. In the context of increasing cannabis use rates, our findings support preoperative screening for cannabis use disorder as a component of perioperative risk stratification. However, further research is needed to quantify the perioperative impact of cannabis use by route and dosage and to inform recommendations for preoperative cannabis cessation.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2023.2403","type":"journal-article","created":{"date-parts":[[2023,7,5]],"date-time":"2023-07-05T11:06:44Z","timestamp":1688555204000},"page":"935","source":"Crossref","is-referenced-by-count":63,"title":["Cannabis Use Disorder and Perioperative Complications"],"prefix":"10.1001","volume":"158","author":[{"given":"Paul P.","family":"Potnuru","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Srikar","family":"Jonna","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"II","given":"George W.","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Critical Care and Pain Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"key":"soi230039r1","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.108494","article-title":"Quarterly trends in past-month cannabis use in the United States, 2015-2019.","volume":"219","author":"Palamar","year":"2021","journal-title":"Drug Alcohol Depend"},{"issue":"1","key":"soi230039r3","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1038\/npp.2017.198","article-title":"US epidemiology of cannabis use and associated problems.","volume":"43","author":"Hasin","year":"2018","journal-title":"Neuropsychopharmacology"},{"issue":"12","key":"soi230039r4","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1001\/jamapsychiatry.2015.1858","article-title":"Prevalence of marijuana use disorders in the United States between 2001-2002 and 2012-2013.","volume":"72","author":"Hasin","year":"2015","journal-title":"JAMA Psychiatry"},{"issue":"1","key":"soi230039r5","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1038\/s41572-021-00247-4","article-title":"Cannabis use and cannabis use disorder.","volume":"7","author":"Connor","year":"2021","journal-title":"Nat Rev Dis Primers"},{"key":"soi230039r6","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1186\/s13741-019-0127-x","article-title":"Cannabis-based medicines and the perioperative physician.","volume":"8","author":"Tapley","year":"2019","journal-title":"Perioper Med (Lond)"},{"key":"soi230039r7","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1016\/j.jclinane.2019.03.011","article-title":"Perioperative care of cannabis users: a comprehensive review of pharmacological and anesthetic considerations.","volume":"57","author":"Echeverria-Villalobos","year":"2019","journal-title":"J Clin Anesth"},{"issue":"16","key":"soi230039r8","doi-asserted-by":"publisher","first-page":"1757","DOI":"10.1016\/j.jcin.2021.06.036","article-title":"Marijuana use and in-hospital outcomes after percutaneous coronary intervention in Michigan, United States.","volume":"14","author":"Yoo","year":"2021","journal-title":"JACC Cardiovasc Interv"},{"issue":"7","key":"soi230039r9","doi-asserted-by":"publisher","first-page":"313","DOI":"10.5435\/JAAOS-D-21-00703","article-title":"The association of cannabis use disorder and perioperative complications after primary total knee arthroplasty.","volume":"30","author":"Weisberg","year":"2022","journal-title":"J Am Acad Orthop Surg"},{"issue":"11","key":"soi230039r10","doi-asserted-by":"publisher","first-page":"734","DOI":"10.1097\/BRS.0000000000004035","article-title":"Cannabis abuse and perioperative complications following inpatient spine surgery in the United States.","volume":"46","author":"Chiu","year":"2021","journal-title":"Spine (Phila Pa 1976)"},{"key":"soi230039r11","doi-asserted-by":"publisher","first-page":"e184","DOI":"10.1016\/j.wneu.2021.10.156","article-title":"Cannabis abuse and perioperative complications after treatment of intracranial aneurysms: a nationwide analysis.","volume":"158","author":"Chiu","year":"2022","journal-title":"World Neurosurg"},{"key":"soi230039r12","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.avsg.2021.10.069","article-title":"Outcomes of infrainguinal bypass in patients with cannabis vs opioid use disorder.","volume":"82","author":"Narayanan","year":"2022","journal-title":"Ann Vasc Surg"},{"issue":"4","key":"soi230039r13","doi-asserted-by":"publisher","first-page":"1376","DOI":"10.1016\/j.jvs.2020.07.094","article-title":"Cannabis use disorder and perioperative outcomes in vascular surgery.","volume":"73","author":"McGuinness","year":"2021","journal-title":"J Vasc Surg"},{"issue":"4","key":"soi230039r14","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1097\/ALN.0000000000003067","article-title":"Cannabis use disorder and perioperative outcomes in major elective surgeries: a retrospective cohort analysis.","volume":"132","author":"Goel","year":"2020","journal-title":"Anesthesiology"},{"issue":"8","key":"soi230039r15","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1136\/rapm-2021-102479","article-title":"Effect of preoperative cannabis use on perioperative outcomes: a retrospective cohort study.","volume":"46","author":"Zhang","year":"2021","journal-title":"Reg Anesth Pain Med"},{"issue":"1","key":"soi230039r16","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1007\/s11695-020-04962-x","article-title":"Effects of perioperative cannabis use on bariatric surgical outcomes: a systematic review.","volume":"31","author":"Jung","year":"2021","journal-title":"Obes Surg"},{"issue":"1","key":"soi230039r17","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1016\/j.bja.2020.09.026","article-title":"Perioperative Pain and Addiction Interdisciplinary Network (PAIN): consensus recommendations for perioperative management of cannabis and cannabinoid-based medicine users by a modified Delphi process.","volume":"126","author":"Ladha","year":"2021","journal-title":"Br J Anaesth"},{"issue":"3","key":"soi230039r18","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1136\/rapm-2022-104013","article-title":"ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids.","volume":"48","author":"Shah","year":"2023","journal-title":"Reg Anesth Pain Med"},{"key":"soi230039r20","doi-asserted-by":"publisher","first-page":"e393","DOI":"10.1016\/j.wneu.2018.11.180","article-title":"Tobacco use and complications following spinal fusion: a comparison of the National Surgical Quality Improvement Program and National Inpatient Sample datasets.","volume":"123","author":"Durand","year":"2019","journal-title":"World Neurosurg"},{"key":"soi230039r21","first-page":"542","article-title":"The evaluation of clinical classifications software using the National Inpatient Sample database.","volume":"2020","author":"Salsabili","year":"2020","journal-title":"AMIA Jt Summits Transl Sci Proc"},{"issue":"5","key":"soi230039r22","doi-asserted-by":"publisher","first-page":"e612","DOI":"10.1212\/CPJ.0000000000001046","article-title":"Impact of ICD-9 to ICD-10 coding transition on prevalence trends in neurology.","volume":"11","author":"Hamedani","year":"2021","journal-title":"Neurol Clin Pract"},{"issue":"9596","key":"soi230039r23","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.1016\/S0140-6736(07)61602-X","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.","volume":"370","author":"von Elm","year":"2007","journal-title":"Lancet"},{"issue":"20","key":"soi230039r24","doi-asserted-by":"publisher","first-page":"2011","DOI":"10.1001\/jama.2017.17653","article-title":"Adherence to methodological standards in research using the National Inpatient Sample.","volume":"318","author":"Khera","year":"2017","journal-title":"JAMA"},{"issue":"8","key":"soi230039r25","doi-asserted-by":"publisher","DOI":"10.1093\/jnci\/djw323","article-title":"Reporting and guidelines in propensity score analysis: a systematic review of cancer and cancer surgical studies.","volume":"109","author":"Yao","year":"2017","journal-title":"J Natl Cancer Inst"},{"key":"soi230039r27","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2020.108113","article-title":"Multiple drug use disorder diagnoses among drug-involved hospitalizations in the United States: results from the 2016 National Inpatient Sample.","volume":"213","author":"Zhu","year":"2020","journal-title":"Drug Alcohol Depend"},{"key":"soi230039r28","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2021.108757","article-title":"Cannabis-related diagnosis in pregnancy and adverse maternal and infant outcomes.","volume":"225","author":"Bandoli","year":"2021","journal-title":"Drug Alcohol Depend"},{"issue":"3","key":"soi230039r29","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1097\/MLR.0000000000000649","article-title":"Deriving ICD-10 codes for patient safety indicators for large-scale surveillance using administrative hospital data.","volume":"55","author":"Southern","year":"2017","journal-title":"Med Care"},{"issue":"3","key":"soi230039r30","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1136\/bmjqs-2018-008852","article-title":"Validation of new ICD-10-based patient safety indicators for identification of in-hospital complications in surgical patients: a study of diagnostic accuracy.","volume":"29","author":"McIsaac","year":"2020","journal-title":"BMJ Qual Saf"},{"issue":"3","key":"soi230039r31","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000003448","article-title":"The effects of cannabis: implications for the surgical patient.","volume":"9","author":"Copeland-Halperin","year":"2021","journal-title":"Plast Reconstr Surg Glob Open"},{"issue":"28","key":"soi230039r34","doi-asserted-by":"publisher","first-page":"2920","DOI":"10.1002\/sim.3944","article-title":"Bias and efficiency of multiple imputation compared with complete-case analysis for missing covariate values.","volume":"29","author":"White","year":"2010","journal-title":"Stat Med"},{"issue":"25","key":"soi230039r36","doi-asserted-by":"publisher","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples.","volume":"28","author":"Austin","year":"2009","journal-title":"Stat Med"},{"issue":"28","key":"soi230039r37","doi-asserted-by":"publisher","first-page":"2890","DOI":"10.1002\/sim.v29:28","article-title":"Factors affecting power of tests for multiple binary outcomes.","volume":"29","author":"Mascha","year":"2010","journal-title":"Stat Med"},{"issue":"6","key":"soi230039r38","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.1213\/ANE.0b013e31821796d3","article-title":"Statistical grand rounds: design and analysis of studies with binary- event composite endpoints: guidelines for anesthesia research.","volume":"112","author":"Mascha","year":"2011","journal-title":"Anesth Analg"},{"issue":"5","key":"soi230039r39","doi-asserted-by":"publisher","first-page":"1378","DOI":"10.1213\/ANE.0000000000005398","article-title":"Count data in medical research: Poisson regression and negative binomial regression.","volume":"132","author":"Schober","year":"2021","journal-title":"Anesth Analg"},{"issue":"3","key":"soi230039r40","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1111\/jep.2007.13.issue-3","article-title":"New models for old questions: generalized linear models for cost prediction.","volume":"13","author":"Moran","year":"2007","journal-title":"J Eval Clin Pract"},{"issue":"3","key":"soi230039r41","doi-asserted-by":"publisher","first-page":"399","DOI":"10.1080\/00273171.2011.568786","article-title":"An introduction to propensity score methods for reducing the effects of confounding in observational studies.","volume":"46","author":"Austin","year":"2011","journal-title":"Multivariate Behav Res"},{"issue":"15","key":"soi230039r42","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.1097\/BRS.0b013e31828e2747","article-title":"Effect of smoking on the perioperative outcomes of patients who undergo elective spine surgery.","volume":"38","author":"Seicean","year":"2013","journal-title":"Spine (Phila Pa 1976)"},{"issue":"4","key":"soi230039r43","doi-asserted-by":"publisher","first-page":"837","DOI":"10.1097\/ALN.0b013e318210f560","article-title":"Smoking and perioperative outcomes.","volume":"114","author":"Turan","year":"2011","journal-title":"Anesthesiology"},{"key":"soi230039r44","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinane.2022.110915","article-title":"Impact of cesarean versus vaginal delivery on the risk of postpartum acute kidney injury: a retrospective database controlled study in 116,876 parturients.","volume":"82","author":"Potnuru","year":"2022","journal-title":"J Clin Anesth"},{"issue":"2","key":"soi230039r46","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1002\/pst.v10.2","article-title":"Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies.","volume":"10","author":"Austin","year":"2011","journal-title":"Pharm Stat"},{"issue":"1","key":"soi230039r47","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1177\/0962280214543508","article-title":"Double propensity-score adjustment: a solution to design bias or bias due to incomplete matching.","volume":"26","author":"Austin","year":"2017","journal-title":"Stat Methods Med Res"},{"issue":"1","key":"soi230039r48","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1093\/biostatistics\/kxx063","article-title":"It\u2019s all about balance: propensity score matching in the context of complex survey data.","volume":"20","author":"Lenis","year":"2019","journal-title":"Biostatistics"},{"key":"soi230039r49","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1002\/pds.3263","article-title":"One-to-many propensity score matching in cohort studies.","volume":"21","author":"Rassen","year":"2012","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"soi230039r50","doi-asserted-by":"publisher","first-page":"67","DOI":"10.6339\/JDS.2006.04(1).233","article-title":"A comparison of propensity score and linear regression analysis of complex survey data.","volume":"4","author":"Zanutto","year":"2006","journal-title":"J Data Sci"},{"issue":"7","key":"soi230039r51","doi-asserted-by":"publisher","first-page":"866","DOI":"10.1111\/acem.2012.19.issue-7","article-title":"Comparing least-squares and quantile regression approaches to analyzing median hospital charges.","volume":"19","author":"Olsen","year":"2012","journal-title":"Acad Emerg Med"},{"issue":"4","key":"soi230039r52","doi-asserted-by":"publisher","first-page":"820","DOI":"10.1213\/ANE.0000000000004017","article-title":"Quantile regression and its applications: a primer for anesthesiologists.","volume":"128","author":"Staffa","year":"2019","journal-title":"Anesth Analg"},{"issue":"3","key":"soi230039r54","doi-asserted-by":"publisher","first-page":"548","DOI":"10.1213\/ANE.0000000000005880","article-title":"An overview of commonly used data sources in observational research in anesthesia.","volume":"134","author":"Zhong","year":"2022","journal-title":"Anesth Analg"},{"key":"soi230039r55","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.drugpo.2017.11.008","article-title":"Routes of administration for cannabis use\u2014basic prevalence and related health outcomes: a scoping review and synthesis.","volume":"52","author":"Russell","year":"2018","journal-title":"Int J Drug Policy"},{"key":"soi230039r56","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1146\/publhealth.2016.37.issue-1","article-title":"Using electronic health records for population health research: a review of methods and applications.","volume":"37","author":"Casey","year":"2016","journal-title":"Annu Rev Public Health"},{"issue":"10","key":"soi230039r57","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1176\/appi.ajp.22010034","article-title":"Trends in cannabis use disorder diagnoses in the U.S. Veterans Health Administration, 2005-2019.","volume":"179","author":"Hasin","year":"2022","journal-title":"Am J Psychiatry"},{"issue":"1","key":"soi230039r58","doi-asserted-by":"publisher","first-page":"41","DOI":"10.1093\/biomet\/70.1.41","article-title":"The central role of the propensity score in observational studies for causal effects.","volume":"70","author":"Rosenbaum","year":"1983","journal-title":"Biometrika"},{"key":"soi230039r59","doi-asserted-by":"publisher","first-page":"185","DOI":"10.2147\/CLEP","article-title":"Confounding in observational studies based on large health care databases: problems and potential solutions\u2014a primer for the clinician.","volume":"9","author":"N\u00f8rgaard","year":"2017","journal-title":"Clin Epidemiol"},{"key":"soi230039r2","volume-title":"Key Substance Use and Mental Health Indicators in the United States: Results From the 2019 National Survey on Drug Use and Health","author":"Substance Abuse and Mental Health Services Administration","year":"2020"},{"key":"soi230039r19","year":"2021"},{"key":"soi230039r32","volume-title":"Elixhauser Comorbidity Software Refined for ICD-10-CM","author":"Healthcare Cost and Utilization Project (HCUP)","year":"2021"},{"key":"soi230039r33","author":"Houchens","year":"2005"},{"key":"soi230039r35","author":"Yang","year":"2012"},{"key":"soi230039r45","author":"Yuan","year":"2017"},{"key":"soi230039r26","unstructured":"Healthcare Cost and Utilization Project (HCUP). Clinical Classifications Software for Services and Procedures. Agency for Healthcare Research and Quality. May 2021. Accessed November 3, 2022. http:\/\/www.hcup-us.ahrq.gov\/toolssoftware\/ccs_svcsproc\/ccssvcproc.jsp"},{"key":"soi230039r53","unstructured":"United Nations Office on Drugs and Crime. World drug report 2022. 2022. Accessed December 3, 2022. https:\/\/www.unodc.org\/unodc\/data-and-analysis\/world-drug-report-2022.html"}],"container-title":["JAMA Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/articlepdf\/2806774\/jamasurgery_potnuru_2023_oi_230039_1694030432.50307.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T11:08:58Z","timestamp":1694603338000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamasurgery\/fullarticle\/2806774"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,1]]},"references-count":59,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamasurg.2023.2403","relation":{},"ISSN":["2168-6254"],"issn-type":[{"value":"2168-6254","type":"print"}],"subject":[],"published":{"date-parts":[[2023,9,1]]}}}