M. Khurrum1, M. Douglas1, M. Chehab1, S. Asmar1, M. Ditillo1, L. Bible1, L. Castanon1, N. Kulvatunyou1, B. Joseph1 1University Of Arizona,Department Of Surgery, Division Of Trauma, Critical Care, Burn And Emergency Surgery,Tucson, AZ, USA
Introduction:
Rib fractures are common in the trauma population. Marijuana (THC) use is associated with low bone density and high bone turnover, increasing the risk of fractures following trauma. The use of marijuana also poses a significant detrimental effect on the trauma population. The effect of marijuana use in rib fracture patients is unknown. Our study aims to investigate the associations between recreational marijuana use and outcomes in trauma patients with rib fractures.
Methods:
We performed a 2016-2017 retrospective analysis of the trauma quality improvement program (TQIP). All adult (age >18) trauma patients with rib fractures were included. Patients were stratified into two groups: chronic marijuana user (THC) and non-marijuana users (No-THC). A 1:1 ratio propensity score matching was performed adjusting for demographics, vital parameters, mechanism of injury, injury severity score (ISS), body regions abbreviated injury score (AIS), solid organ injuries, number of rib fractures, comorbidities, and smoking history. Outcome measures were in-hospital complications, in-hospital length of stay (LOS), and mortality
Results:
Of the 145,416 rib fracture patients, 21,166 patients (THC: 10,583; No-THC: 10,583) were matched. The mean age was 38±15 years, 78% were males, 91% of patients had a blunt mechanism of injury, 73% had multiple rib fractures, and the median injury severity score was 30 [22-36]. The overall rate of in-hospital complications was 16%, and mortality was 4.8%. THC is associated with increased respiratory complications (2.8% vs. 1.6%, P<0.001) and unplanned intubation (2.3% vs. 1.7%, P<0.001), but not ventilator-associated pneumonia (1.9% vs. 1.7%, P=0.469). Overall in-hospital complications were higher in THC (16.4% vs. 14.9%, P=0.002) as compared to No-THC. In-hospital length of stay was significantly higher in THC (4.9 [2.1-10.8] vs. 4.0 [1.7-8.7], P<0.001). There was no significant difference in mortality between the two groups (4.6% vs. 5.0%, P=0.199).
Conclusion:
THC use increases the risk of in-hospital complications in trauma patients with rib fractures. Cannabis use negatively impacts patient outcomes. Early identification and screening of cannabis in trauma patients with rib fractures is warranted and may improve their outcomes.