Cannabis use disorder increased post-surgical cardiovascular risk by 26% in a study of 289,000 patients

Among 288,923 adults undergoing noncardiac surgery, patients with a diagnosed cannabis use disorder had 26% higher odds of major adverse cardiovascular or cerebrovascular events (MACCE) within one year (aOR 1.26, 95% CI: 1.05-1.51). For recreational users, the association depended on baseline cardiac risk: high-risk patients (RCRI class III/IV) had 41% higher odds (aOR 1.41, 95% CI: 1.15-1.74), while low-risk patients showed no significant association (aOR 0.87, 95% CI: 0.75-1.02).

Retrospective cohort of 288,923 adult patients undergoing noncardiac surgery between 2008-2020 at a tertiary academic hospital in Massachusetts. Cannabis use differentiated into self-reported recreational use and diagnosed cannabis use disorder. Primary outcome: MACCE (ischemic stroke, cardiac arrest, heart failure, MI, revascularization) within one year.

This is one of the largest studies linking cannabis use to post-surgical cardiovascular complications. The critical finding that risk depends on both the type of cannabis use (disorder vs recreational) and baseline cardiac risk provides actionable information for surgical risk assessment.

As cannabis use increases among surgical candidates, pre-operative risk assessment needs to incorporate cannabis use history. This study provides the nuance that not all cannabis use carries the same surgical risk: diagnosed cannabis use disorder and high baseline cardiac risk are the key risk modifiers.

Single-center retrospective study from Massachusetts. Cannabis use may be underreported. Cannot determine whether cannabis was used in the perioperative period specifically. Observational design cannot establish causation. Recreational use was self-reported while CUD was diagnosed, potentially reflecting different assessment rigor.