Among nearly 289,000 surgical patients, cannabis use disorder was associated with 26% higher odds of major cardiovascular events within one year, while recreational use increased risk only in patients with high baseline cardiac risk.
Anesthesiologists, surgeons, cardiac risk assessment specialists, perioperative medicine physicians
26% higher cardiovascular event risk with cannabis use disorder
What the researchers found
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).
Why it matters
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.
The numbers in context
n=288,923; CUD: aOR 1.26 (95% CI: 1.05-1.51); recreational + high cardiac risk: aOR 1.41 (95% CI: 1.15-1.74); recreational + low cardiac risk: aOR 0.87 (95% CI: 0.75-1.02); 2008-2020 study period
How the study worked
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.
What this study cannot tell us
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.
How to read the evidence
Very large single-center cohort with differentiated cannabis use exposure and risk stratification provides strong evidence, limited by retrospective design and potential underreporting.
When this study was published
2025 publication analyzing 2008-2020 surgical data
The bigger picture
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.
Questions still open
- Should cannabis cessation before elective surgery be recommended for patients with high cardiac risk? Does the cardiovascular risk from cannabis use disorder reflect the effects of cannabis itself or associated lifestyle factors?
Common questions
Does recreational cannabis use increase surgical risk?
What is cannabis use disorder vs recreational use?
Read the original research
Association of cannabis use with major cardiovascular and cerebrovascular events after surgery or interventional procedures.
The American journal on addictions, 34(5), 517-527
Citation
Ashrafian, Sarah; Ahrens, Elena; Wachtendorf, Luca J; Munoz-Acuna, Ricardo; Shay, Denys; Suleiman, Aiman; Redaelli, Simone; von Wedel, Dario; Chen, Guanqing; Wolff, Georg; Hill, Kevin P; Schaefer, Maximilian S. (2025). Association of cannabis use with major cardiovascular and cerebrovascular events after surgery or interventional procedures.. The American journal on addictions, 34(5), 517-527. https://doi.org/10.1111/ajad.70029