Among over 558,000 adolescents who underwent surgery, those with cannabis use disorder had significantly higher odds of respiratory complications, ICU admission, mechanical ventilation, and extended hospital stays.
Pediatric surgeons and anesthesiologists; parents of adolescents facing surgery.
2.41x higher odds of mechanical ventilation in adolescent surgical patients with CUD
What the researchers found
CUD prevalence in adolescent surgical patients increased from 0.4% in 2009 to 0.6% in 2022. Adolescents with CUD had significantly higher adjusted odds of respiratory complications (OR 1.52), ICU admission (OR 1.78), mechanical ventilation (OR 2.41), and extended hospital stays (OR 1.96). Mortality and stroke risks were not significantly increased after Bonferroni correction.
Why it matters
This is the largest study to date examining how cannabis use disorder affects surgical outcomes in teens. The 2.4-fold increase in mechanical ventilation risk is particularly concerning and suggests CUD should be part of preoperative assessment and counseling for adolescents.
The numbers in context
558,721 adolescents. 2,604 (0.5%) with CUD. CUD prevalence increased from 0.4% (2009) to 0.6% (2022), p < .001. Adjusted ORs: respiratory complications 1.52 (1.16-2.00), ICU admission 1.78 (1.61-1.98), mechanical ventilation 2.41 (2.10-2.77), extended hospital stay 1.96 (1.74-2.20). All p < .001 except respiratory (p = .002).
How the study worked
Retrospective 1:1 propensity-matched cohort study of 558,721 adolescents (ages 10-17) undergoing inpatient surgery at US hospitals in the Pediatric Health Information System from 2009-2022. 2,604 had CUD diagnoses; 2,483 were propensity matched. Bonferroni-corrected significance threshold: p < .008.
What this study cannot tell us
CUD was identified by diagnostic codes, which likely undercount actual cannabis use. The study cannot distinguish between active use and historical CUD diagnosis. Propensity matching cannot account for unmeasured confounders like the severity of the underlying surgical condition.
How to read the evidence
Strong: very large multicenter database with propensity matching, Bonferroni correction, and consistent findings across multiple outcomes.
When this study was published
2024 study using 2009-2022 data.
The bigger picture
As cannabis use disorder becomes more common among adolescents, perioperative teams need to account for its effects on recovery. The respiratory and ICU findings suggest cannabis-related airway and pulmonary effects may be clinically significant even in young patients.
Questions still open
- Would preoperative cannabis cessation reduce complication rates? What is the mechanism behind the increased mechanical ventilation risk -- is it primarily respiratory or related to altered anesthetic metabolism?
Common questions
Why does cannabis use disorder increase surgical risks?
Is the risk increasing over time?
Read the original research
Trends in Adolescent Comorbid Cannabis Use Disorder and Postoperative Complications.
Pediatrics, 153(6)
Citation
Willer, Brittany L; Mpody, Christian; Nafiu, Olubukola O. (2024). Trends in Adolescent Comorbid Cannabis Use Disorder and Postoperative Complications.. Pediatrics, 153(6). https://doi.org/10.1542/peds.2024-065757
Explore the wider topic
- How to Talk to Your Teenager About Weed (Without Losing Them)
- My Kid's Friends Smoke Weed: A Parent's Guide
- I Smoke Weed But Don't Want My Kids To: Navigating the Hypocrisy
- Quitting Weed as a Parent: Why It Is the Hardest and Most Important Quit
- Quitting Weed as a Teen or Young Adult
- My Kid Is Smoking Weed: A Parent's Guide