O. Ziegler1, S. Dalessio3, A.C. Greene1, M.D. Coates3, A.S. Kulaylat2 1Penn State University College Of Medicine, Department Of Surgery, Hershey, PA, USA 2Penn State University College Of Medicine, Department Of Surgery, Division Of Colon And Rectal Surgery, Hershey, PA, USA 3Penn State University College Of Medicine, Department Of Medicine, Division Of Gastroenterology And Hepatology, Hershey, PA, USA
Introduction: Perioperative use of cannabis has increased in the wake of widespread decriminalization in the United States. The impact of cannabis use on patients undergoing surgery remains understudied, especially in those with inflammatory bowel disease (IBD) where cannabis use rates may be as high as 40%.
Methods: We employ TriNetX Diamond Network, a database of electronic medical records and insurance claims, to examine the impact of cannabis use after colorectal surgery (CRS) in patients with IBD on opioid use, emergency department (ED) visits, readmission, IBD-related complications (fistula development, bowel obstruction) and endoscopic or surgical intervention. We hypothesized that cannabis use (defined in table 1) would be associated with changes in postoperative healthcare utilization. Patients were excluded if they had a cancer diagnosis or a diagnosis of both ulcerative colitis and Crohn’s disease.
Following cohort identification, patients underwent propensity score matching on the basis of age, sex, IBD type, smoking status, and comorbidities. Rates of the aforementioned outcomes were compared between the matched cohorts, beginning one month following index surgery and continuing for six months. Odds ratios were generated on this basis, pre-selected alpha was 0.05. All statistical analysis was performed in TriNetX.
Results: Before matching, 122 and 15,239 patients were included in the cannabis user and never user cohorts respectively. After matching, 121 patients remained in each group. Cannabis users were more likely to visit the ED (CI=1.59–4.51, p=0.0002), and use opioids (CI=1.05-3.08, p=0.0307) when compared to non-users. No differences in endoscopic (CI: 0.4-2.5, p=1.00) or surgical (CI: 0.86-4.40, p=0.108) re-intervention were appreciated. Nor were there differences in IBD-related complications (CI:0.68-3.44, p=0.3073), hospital readmission (CI: 0.40–2.50, p=1.00) or post-operative steroid use (CI: 0.72-2.94, p=0.2891).
Conclusion: Cannabis users experienced significantly higher rates of opioid use and ED visits after CRS compared to those who do not use cannabis, even after matching for relevant clinical and demographic factors. Further investigation is warranted to elucidate the causes for these findings. However, the lack of significant differences in rates of steroid use, hospital readmission, IBD-related complications, and surgical or endoscopic re-intervention, suggests that these findings are less likely to be related to a cannabis-driven impact on IBD activity.