{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T04:43:43Z","timestamp":1792212223552,"version":"4.4.0"},"reference-count":40,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:00:00Z","timestamp":1792108800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Laryngoscope"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Goal<\/jats:title>\n                    <jats:p>This study investigates the risk of prolonged postoperative opioid use and functional outcomes of free flap reconstruction in head and neck cancer patients with a history of cannabis use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Patients undergoing head and neck free flap reconstruction (2005\u20132025) were identified using the\n                      <jats:styled-content style=\"fixed-case\">TriNetX<\/jats:styled-content>\n                      database and stratified by cannabis use. Cohorts were propensity score\u2013matched for demographics, substance use, and tumor characteristics. The primary outcome was postoperative opioid use at 3\u201312\u2009months; secondary outcomes included tracheostomy and gastrostomy dependence. Multivariable Cox regression adjusted for behavioral health comorbidities.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      After matching, each cohort (cannabis users and non\u2010users) consisted of 532 patients. Cannabis users were more likely to be gastrostomy tube dependent at 3\u2009months (\n                      <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\n                      : 1.56, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      : [1.19\u20132.04]). Preoperative cannabis use increased the risk of prolonged postoperative opioid use at 3\u20136\u2009months (\n                      <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\n                      : 1.19, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      : [1.05\u20131.36]), 6\u20139\u2009months (\n                      <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\n                      : 1.35, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      : [1.13\u20131.62]), and 9\u201312\u2009months (\n                      <jats:styled-content style=\"fixed-case\">RR<\/jats:styled-content>\n                      : 1.26, 95%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      : [1.04\u20131.52]). There was no significant difference in tracheostomy dependence at any time point. In adjusted Cox regression analysis, perioperative cannabis persisted as independently associated with prolonged opioid use (\n                      <jats:styled-content style=\"fixed-case\">HR<\/jats:styled-content>\n                      : 1.42, 90%\n                      <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\n                      : [1.14, 1.76]).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Head and neck cancer patients with a history of cannabis use demonstrate increased risk of prolonged opioid use after free flap reconstructive surgery even after adjusting for behavioral health comorbidities, highlighting the need for targeted pain management strategies and closer postoperative monitoring in this patient population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence<\/jats:title>\n                    <jats:p>3<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/lary.71002","type":"journal-article","created":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T04:35:46Z","timestamp":1792211746000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cannabis Use and Prolonged Opioid Utilization After Head and Neck Free Flap Reconstructive Surgery"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8355-4804","authenticated-orcid":false,"given":"Ella P.","family":"Jackert","sequence":"first","affiliation":[{"name":"Keck School of Medicine of the University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Gallagher","sequence":"additional","affiliation":[{"name":"USC Caruso Department of Otolaryngology \u2013 Head and Neck Surgery Keck School of Medicine of USC  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mmasiolu","family":"Gamero","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of the University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-0831-4413","authenticated-orcid":false,"given":"Zachary","family":"Thompson","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of the University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Albert","family":"Li","sequence":"additional","affiliation":[{"name":"Keck School of Medicine of the University of Southern California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7388-6373","authenticated-orcid":false,"given":"Niels C.","family":"Kokot","sequence":"additional","affiliation":[{"name":"USC Caruso Department of Otolaryngology \u2013 Head and Neck Surgery Keck School of Medicine of USC  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,16]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1067\/mhn.2001.116788"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010021\u201082034\u20105"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.7181\/acfs.2020.00745"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/01945998211044683"},{"issue":"3","key":"e_1_2_9_6_1","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1001\/jamaoto.2016.2981","article-title":"Optimal Perioperative Care in Major Head and Neck Cancer Surgery With Free Flap Reconstruction: A Consensus Review and Recommendations From the Enhanced Recovery After Surgery Society","volume":"143","author":"Dort J. 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