Cannabis Use Linked to Higher Infection and Reoperation Rates After Arm Fracture Surgery | Research

The takeaway

Cannabis users undergoing upper extremity fracture surgery had significantly higher rates of implant infection, reoperation, readmission, depression, and anxiety compared to non-users, though nicotine users had even more complications overall.

Orthopedic surgeons, trauma surgeons, anesthesiologists, perioperative care teams, and patients using cannabis who need surgery.

What the researchers found

Cannabis-only users had significantly higher rates of implant-related infection, reoperation, readmission, depression, and anxiety vs. matched non-users (all p<0.05), while nicotine-only users showed even broader complications including nonunion, wound dehiscence, pneumonia, chronic pain, and mortality.

Why it matters

Unlike elective surgery where patients can quit smoking, trauma patients cannot delay fracture repair — making it critical to understand cannabis-related risks so surgeons can adjust perioperative care.

The numbers in context

Cannabis n=801; nicotine n=14,310; concurrent n=901; 1-year outcomes; cannabis users: higher infection, reoperation, readmission, depression, anxiety (all p<0.05); concurrent use did not show additive risk vs. cannabis alone

How the study worked

Retrospective analysis of the TriNetX database (2015-2023) comparing four propensity score-matched cohorts — cannabis-only (n=801), nicotine-only (n=14,310), concurrent users (n=901), and matched non-users — examining 1-year surgical, medical, and psychosocial outcomes after upper extremity fracture fixation.

What this study cannot tell us

Retrospective database study with inherent coding limitations; cannabis use likely underreported; propensity matching cannot account for all confounders; small cannabis-only cohort; concurrent user group may lack power to detect additive effects; 1-year follow-up.

How to read the evidence

Large database study with propensity score matching provides reasonable evidence, but retrospective design, potential coding inaccuracies, and relatively small cannabis cohort limit conclusions.

When this study was published

Published 2026; covers 2015-2023.

The bigger picture

As cannabis use grows, orthopedic surgeons need to screen for and plan around cannabis-related perioperative risks, just as they currently do for nicotine use.

Questions still open

What biological mechanisms link cannabis to implant infection? Would perioperative cannabis cessation improve outcomes? Should extended antibiotic prophylaxis be standard for cannabis users undergoing fracture fixation?

Common questions

Does cannabis use affect surgery outcomes?

This study found that cannabis users had significantly higher rates of implant infection, reoperation, readmission, depression, and anxiety after upper extremity fracture surgery compared to matched non-users.

Is cannabis or nicotine worse for surgical recovery?

Nicotine users had a broader range of complications (including nonunion, wound problems, pneumonia, and mortality), but cannabis users also had significantly elevated risks — and using both together did not appear to create additional risk beyond each substance alone.

Read the original research

Cannabis and nicotine use are independently associated with adverse surgical, medical, and psychosocial outcomes following upper extremity fracture fixation.

Journal of orthopaedic surgery and research, 21(1), 127

View on PubMed ↗Publisher’s paper ↗

Citation

Hamad, Christopher D; Galoustian, Nora A; Wiener, Joshua; Yusin, Nick; Liu, Timothy; Olson, Thomas; Walker, Paul; Shahamatdar, Soroush; Nwufo, Michelle; Golzar, Autreen; Kaelber, David C; Bernthal, Nicholas M; Lee, Christopher; Sheppard, William L. (2026). Cannabis and nicotine use are independently associated with adverse surgical, medical, and psychosocial outcomes following upper extremity fracture fixation.. Journal of orthopaedic surgery and research, 21(1), 127. https://doi.org/10.1186/s13018-025-06635-w