Cannabis Use Disorder Rising Among Urologic Cancer Surgery Patients, With Longer Hospital Stays

What the researchers found

CUD incidence rose from 51 to 383 per 100,000 admissions between 2003-2014. On multivariable analysis, CUD was not an independent predictor of major complications (p=0.6) but was independently associated with high length of stay (OR=1.31) and high inpatient cost (OR=1.33). CUD patients were significantly younger (median 37 vs 51 years) and had higher rates of opioid abuse.

Why it matters

The 7-fold increase in CUD prevalence among surgical oncology patients reflects broader trends in cannabis use. The finding that CUD increases hospital stays and costs without increasing complications suggests logistical or behavioral factors (not surgical risk) are driving the difference.

The numbers in context

CUD incidence: 51/100,000 (2003) to 383/100,000 (2014). 1,612,743 patients. CUD median age: 37 vs 51 years. Complications: 32% vs 15% (unadjusted) but not significant on MVA. LOS: 3 vs 2 days (p<0.001). Cost: $15,609 vs $12,415. OR for high LOS: 1.31. OR for high cost: 1.33.

How the study worked

Analysis of the National Inpatient Sample (2003-2014) including 1,612,743 patients undergoing prostatectomy, nephrectomy, or cystectomy. CUD identified via ICD-9 codes. Inverse probability treatment weighting balanced groups on demographics and comorbidities.

What this study cannot tell us

ICD-9 codes for CUD likely undercount cannabis users. Administrative data cannot capture cannabis use that does not reach disorder-level diagnosis. Cannot determine if cannabis was used perioperatively. The dramatic age difference suggests fundamentally different patient populations.

How to read the evidence

Very large national database with appropriate weighting, though administrative coding and unmeasured confounders are limitations.

When this study was published

2024 study using 2003-2014 data

The bigger picture

The disconnect between higher unadjusted complication rates and non-significant adjusted rates suggests that age and comorbidity differences explain the complications, while the independent LOS and cost effects may reflect post-operative management challenges in this population.

Questions still open

• Why are CUD patients hospitalized longer if they do not have more complications? Is it related to pain management challenges, social factors, or discharge planning? Would perioperative cannabis use counseling reduce LOS?

Common questions

Read the original research

The impact of cannabis use disorder on urologic oncologic surgery morbidity, length of stay, and inpatient cost: analysis of the National Inpatient Sample from 2003 to 2014.

World journal of urology, 42(1), 465

Citation

Tinsley, Shane A; Arora, Sohrab; Stephens, Alex; Finati, Marco; Chiarelli, Giuseppe; Cirulli, Giuseppe Ottone; Morrison, Chase; Richard, Caleb; Hares, Keinnan; Rogers, Craig G; Abdollah, Firas. (2024). The impact of cannabis use disorder on urologic oncologic surgery morbidity, length of stay, and inpatient cost: analysis of the National Inpatient Sample from 2003 to 2014.. World journal of urology, 42(1), 465. https://doi.org/10.1007/s00345-024-05151-6

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