Patient reported cannabis use is associated with greater 24-hour postoperative opioid use but shorter length of stay in isolated tibial shaft fractures.

PURPOSE: This study investigates postoperative morphine milligram equivalent (MME) consumption and healthcare utilization in patients using cannabis with tibial shaft fractures treated with intramedullary nail (IMN).

METHODS

A retrospective study at a single-center academic level 1 trauma center was conducted. This included patients with closed, isolated tibial shaft fractures treated with IMN. Patients were grouped based on self-reported cannabis use and compared using demographics, relevant history, comorbidities, baseline medication use, inpatient healthcare utilization, and readmission. The primary outcome was total inpatient MME within the first 24 h postoperatively. Secondary outcomes included length of hospital stay (LOS), total MME requirements for the index postoperative hospital stay, anesthesia requirements, and readmission rates.

RESULTS

Twenty-one percent (45 out of 210) of patients with isolated tibial shaft fractures reported using cannabis prior to fixation. Cannabis users were younger and predominantly male. There were no differences between groups regarding other demographics, comorbidities, or average duration of follow-up; however, cannabis users reported higher rates of nicotine and alcohol use (p < 0.01). Cannabis users had a significantly shorter LOS by 16.8-h. Average inpatient MME requirements were higher among cannabis users compared to non-users in the first 24-h postoperative period (p = 0.02) but similar during entire index hospitalization (p = 0.65). Additionally, the rate of readmission was higher in the cannabis use group (p = 0.04).

CONCLUSIONS

Self-reported cannabis use had a significant effect on acute postoperative pain control in the first 24 h and length of hospital stay in tibial shaft fracture patients treated with intramedullary nailing. This should raise awareness regarding acute pain control in this patient population. More robust studies are needed on the effects of cannabis use on pain control in fracture care management.