Cannabis use disorder was linked to more postoperative pain and skin complications after tummy tuck surgery | Research

The takeaway

In a propensity-matched analysis of 1,596 panniculectomy patients, those with cannabis use disorder had 82% more postoperative pain and 48% more wound complications, but no difference in other major complications.

Plastic surgeons, surgical team members, preoperative assessment clinicians

RR 1.82 for postoperative pain in patients with cannabis use disorder vs. matched controls

What the researchers found

After propensity score matching on age, sex, BMI, race/ethnicity, and comorbidities, patients with CUD had significantly higher rates of postprocedural pain (RR 1.82, 95% CI 1.32-2.46, p < 0.001) and skin complications (RR 1.48, 95% CI 1.05-2.09, p = 0.019). No significant differences were found for sepsis, hematoma/seroma, venous thromboembolism, pulmonary embolism, or hospital readmission.

Why it matters

Surgeons often lack evidence-based guidance on how cannabis use affects surgical outcomes. This large matched analysis provides specific risk estimates for a common procedure, supporting the case for routine cannabis use screening in preoperative assessments.

The numbers in context

1,596 matched patients (798 CUD, 798 controls). Mean age 43.2, 80.3% female. Postprocedural pain RR 1.82 (95% CI 1.32-2.46, p < 0.001). Skin complications RR 1.48 (95% CI 1.05-2.09, p = 0.019). No significant differences in sepsis, hematoma/seroma, VTE, PE, or readmission.

How the study worked

Retrospective cohort study using the TriNetX federated database (100+ healthcare organizations). Adult panniculectomy patients (2010-2025) with CUD documented within 6 months preoperatively were propensity-matched 1:1 to controls. Risk ratios were calculated for 90-day postoperative complications.

What this study cannot tell us

ICD coding for CUD may undercount cannabis users. No data on route, dose, or frequency of cannabis use. Concurrent nicotine use is a potential confounder. Retrospective design with inherent limitations. TriNetX database may have documentation biases.

How to read the evidence

Large propensity-matched study from a multi-institutional database, but retrospective design and reliance on ICD coding for CUD identification introduce potential for misclassification.

When this study was published

2026 publication using 2010-2025 data

The bigger picture

As cannabis use becomes more common, understanding its impact on surgical outcomes becomes increasingly important. The specific pattern here, more pain and wound issues but not systemic complications, suggests cannabis may affect local healing and pain processing rather than causing broad surgical risk.

Questions still open

Is the increased pain due to cannabinoid receptor changes affecting pain processing, or to tolerance to analgesics? Would preoperative cannabis cessation reduce these risks? Do these patterns apply to other surgical procedures?

Common questions

Should cannabis users avoid surgery?

This study does not suggest avoiding surgery, but rather that surgeons should screen for cannabis use and anticipate potentially higher pain management needs and wound monitoring requirements.

Why might cannabis users have more pain after surgery?

Possible explanations include altered pain processing from chronic cannabinoid receptor stimulation, cross-tolerance with anesthetic agents, or differences in pain reporting. The study identified the association but did not test mechanisms.

Read the original research

Association of cannabis use disorder with postoperative complications following panniculectomy: a multicenter propensity-matched analysis.

BMC plastic and reconstructive surgery, 2(1), 1

View on PubMed ↗Publisher’s paper ↗

Citation

Mokhtar, Jonathan; Ha, John Y; Almeida, Victor F A; Lellouch, Alexandre G; Vyas, Krishna S; Doh, Susan J; Duraes, Eliana F R. (2026). Association of cannabis use disorder with postoperative complications following panniculectomy: a multicenter propensity-matched analysis.. BMC plastic and reconstructive surgery, 2(1), 1. https://doi.org/10.1186/s44452-026-00013-z