Cannabis Users Face More Surgical Complications After Hand Fracture Repair Than Non-Users | Research

The takeaway

Among 80,787 patients who underwent metacarpal fracture fixation, cannabis users had higher rates of multiple medical and surgical complications compared to non-users, though fewer complications than tobacco users.

Surgeons, anesthesiologists, cannabis-using patients facing surgery

6.7% of hand fracture patients had cannabis use disorder

What the researchers found

Compared to controls, cannabis users (6.7% of cohort) had higher rates of acute kidney injury, cardiac arrest, DVT, hypoglycemia, MI, pneumonia, sepsis, stroke, UTI, surgical site infection, and fracture malunion after metacarpal fracture fixation. However, compared to tobacco users, cannabis users had fewer complications including lower rates of pneumonia, UTI, and surgical revision.

Why it matters

As surgeons increasingly encounter patients who use cannabis, understanding perioperative risk profiles becomes essential. This large study provides specific complication data that can inform preoperative counseling and perioperative management.

The numbers in context

80,787 patients; 5,043 (6.7%) with cannabis use disorder; higher rates of 9 medical complications and 2 surgical complications vs. controls; fewer complications than tobacco users for several outcomes.

How the study worked

Retrospective analysis of 80,787 patients from a US insurance claims database (2010-2022) who underwent metacarpal fracture fixation. 5,043 had diagnosed cannabis use disorder. Propensity matched for age, sex, and Charlson Comorbidity Index.

What this study cannot tell us

Claims database cannot determine causation. Cannabis use identified by diagnosis codes likely underestimates prevalence and overrepresents heavy users. Cannot control for all confounders. Propensity matching for only three variables.

How to read the evidence

Large propensity-matched claims database study, limited by diagnosis code identification of cannabis use and inability to establish causation.

When this study was published

2025 publication with 2010-2022 data

The bigger picture

Cannabis users may occupy a middle ground for surgical risk: worse than non-users but better than tobacco users. This nuance matters for clinical decision-making and patient counseling.

Questions still open

What specific mechanisms drive the increased surgical complication risk in cannabis users?
Should perioperative protocols be modified for cannabis users undergoing orthopedic surgery?

Common questions

Does cannabis use affect surgery outcomes?

In this study of 80,787 hand fracture surgeries, cannabis users had higher rates of multiple complications including infections, cardiac events, and fracture malunion compared to non-users. However, their complication rates were lower than tobacco users for several outcomes.

Should I stop using cannabis before surgery?

This study found cannabis users had higher surgical complication rates. While it cannot prove cannabis caused the complications, the association is worth discussing with a surgeon before any procedure.

Read the original research

Weeding Out the Problem: Associations of Cannabis and Tobacco Use with Complications of Surgical Fixation of Metacarpal Fracture.

The journal of hand surgery Asian-Pacific volume, 30(5), 506-513

View on PubMed ↗Publisher’s paper ↗

Citation

Kishan, Arman; Bergstein, Victoria E; Kishan, Ansh; Jankowski, Pawel; Tuffaha, Sami H; Laporte, Dawn M. (2025). Weeding Out the Problem: Associations of Cannabis and Tobacco Use with Complications of Surgical Fixation of Metacarpal Fracture.. The journal of hand surgery Asian-Pacific volume, 30(5), 506-513. https://doi.org/10.1142/S2424835525500456