Does Marijuana Smoking Increase the Odds of Surgical Site Infection After Orthopaedic Surgery? A Retrospective Cohort Study.

OBJECTIVES

Does marijuana smoking increase the risk of surgical site infection (SSI) after open reduction and internal fixation of fractures?

DESIGN

Retrospective.

SETTING

Single academic level 1 trauma center in Southern California.

PATIENT SELECTION CRITERIA: Adult patients who underwent open treatment for closed fractures between January 2009 and December 2021, had hardware placed, and had at least 6 months of postoperative follow-up.

OUTCOME MEASURES AND COMPARISONS: Risk factors associated with the development of SSI were compared between current inhalational marijuana users and nonmarijuana users.

RESULTS

Complete data were available on 4802 patients after exclusion of 82 who did not have a complete variable set. At the time of surgery, 24% (1133 patients) were current users of marijuana. At the final follow-up (minimum 6 months), there was a 1.6% infection rate (75 patients). The average age of the infection-free group was 46.1 ± 23.1 years, and the average age of the SSI group was 47.0 ± 20.3 (P = 0.73) years. In total, 2703 patients (57%) in the infection-free group were male compared with 48 (64%) in the SSI group (P = 0.49). On multivariate analysis, longer operative times (OR 1.002 [95% CI, 1.001-1.004]), diabetic status (OR 2.084 [95% CI, 1.225-3.547]), and current tobacco use (OR 2.493 [95% CI, 1.514-4.106]) (P < 0.01 for all) were associated with an increased risk of SSI; however, current marijuana use was not (OR 0.678 [95% CI, 0.228-2.013], P = 0.48).

CONCLUSIONS

Tobacco use, diabetes, and longer operative times were associated with the development of SSI after open reduction and internal fixation of fractures; however, marijuana smoking was not shown to be associated with the development of SSI.

LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.