Cannabis Use Linked to Higher Infection and Reoperation Rates After Arm Fracture Surgery
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.
Quick Facts
What This Study 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.
Key Numbers
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 They Did This
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.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- Evidence Grade:
- Large database study with propensity score matching provides reasonable evidence, but retrospective design, potential coding inaccuracies, and relatively small cannabis cohort limit conclusions.
- Study Age:
- Published 2026; covers 2015-2023.
- Original Title:
- Cannabis and nicotine use are independently associated with adverse surgical, medical, and psychosocial outcomes following upper extremity fracture fixation.
- Published In:
- Journal of orthopaedic surgery and research, 21(1), 127 (2026)
- Authors:
- 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
- Database ID:
- RTHC-08310
Evidence Hierarchy
Looks back at existing records to find patterns.
What do these levels mean? →Frequently Asked 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 More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-08310APA
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
MLA
Hamad, Christopher D, et al. "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, 2026. https://doi.org/10.1186/s13018-025-06635-w
RethinkTHC
RethinkTHC Research Database. "Cannabis and nicotine use are independently associated with ..." RTHC-08310. Retrieved from https://rethinkthc.com/research/hamad-2026-cannabis-and-nicotine-use
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.