Cannabis users had significantly higher rates of infection, nonunion, and reoperation after ankle fracture surgery
In a propensity-matched study of 6,252 patients undergoing ankle fracture surgery, preoperative cannabis use was associated with significantly increased risks of infection (70% higher), nonunion, and reoperation over 3 years.
Quick Facts
What This Study Found
After propensity score matching for 27 confounders, preoperative cannabis use was significantly associated with increased risks of postoperative infection (RR=1.696), nonunion, and reoperation following ankle ORIF. The study applied Bonferroni correction for 34 outcomes with significance set at p<.0015.
Key Numbers
3,126 matched pairs. Infection: RR=1.696 (CI 1.230-2.337, p<.0015). Nonunion and reoperation also significantly elevated at 3 years. Bonferroni correction applied across 34 outcomes. No significant differences in other measured outcomes after correction.
How They Did This
Retrospective cohort analysis using the nationally representative TriNetX Research Network database. 3,126 matched pairs (cannabis users vs. non-users) undergoing ankle fracture ORIF. Propensity score matching controlled for 27 demographic and clinical confounders. Outcomes assessed at 90 days, 6 months, and 3 years.
Why This Research Matters
This study positions cannabis alongside tobacco as a potentially modifiable perioperative risk factor for orthopedic surgery, which could change preoperative counseling and optimization protocols.
The Bigger Picture
Cannabis is increasingly recognized as affecting wound healing and immune function. This large matched cohort adds orthopedic-specific evidence to a growing body of literature suggesting cannabis may impair surgical recovery.
What This Study Doesn't Tell Us
Retrospective database study. Cannabis use identified from records, likely underestimating true prevalence. Cannot determine dose, frequency, or method of cannabis use. Cannot distinguish between recreational and medical use or control for cannabis cessation perioperatively.
Questions This Raises
- ?What biological mechanisms drive the increased infection and nonunion rates?
- ?Would preoperative cannabis cessation reduce these risks, similar to smoking cessation protocols?
- ?Is there a dose-response relationship between cannabis use and surgical complications?
Trust & Context
- Key Stat:
- 70% higher infection risk; increased nonunion and reoperation
- Evidence Grade:
- Strong: large propensity-matched cohort from a national database with stringent Bonferroni correction for multiple comparisons.
- Study Age:
- Published 2026.
- Original Title:
- Preoperative Cannabis Use and Ankle ORIF Outcomes: Higher Risks of Infection, Nonunion, and Reoperation.
- Published In:
- Foot & ankle international, 47(1), 43-51 (2026)
- Database ID:
- RTHC-08672
Evidence Hierarchy
Looks back at existing records to find patterns.
What do these levels mean? →Frequently Asked Questions
Does cannabis use affect surgical outcomes?
In this study of ankle fracture surgery, preoperative cannabis users had 70% higher infection rates and significantly more nonunion and reoperation compared to matched non-users.
Should you stop cannabis before surgery?
This study suggests cannabis may be a modifiable risk factor similar to tobacco. The researchers recommend targeted preoperative counseling, though optimal cessation timing before surgery is not yet established.
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Cite This Study
https://rethinkthc.com/research/RTHC-08672APA
Tummala, Sri; Wood, Brandon A; Mittal, Mehul M; Sambandam, Senthil N; Wukich, Dane K. (2026). Preoperative Cannabis Use and Ankle ORIF Outcomes: Higher Risks of Infection, Nonunion, and Reoperation.. Foot & ankle international, 47(1), 43-51. https://doi.org/10.1177/10711007251385971
MLA
Tummala, Sri, et al. "Preoperative Cannabis Use and Ankle ORIF Outcomes: Higher Risks of Infection, Nonunion, and Reoperation.." Foot & ankle international, 2026. https://doi.org/10.1177/10711007251385971
RethinkTHC
RethinkTHC Research Database. "Preoperative Cannabis Use and Ankle ORIF Outcomes: Higher Ri..." RTHC-08672. Retrieved from https://rethinkthc.com/research/tummala-2026-preoperative-cannabis-use-and
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.