Analysis of Complications in Patients with a History of Cannabis Use and Tobacco Use Undergoing Implant-based or Breast Reconstruction

Goals/Purpose: Marijuana is the most commonly used recreational drug in the United States; 48.2 million people, or about 18% of Americans, used it at least once in 2019. Despite the advancing legalization of marijuana in the United States, there is a paucity of information regarding the perioperative effects of marijuana in breast reconstructive surgeries. The purpose of this study was to explore possible associations between postoperative complications and a history of cannabis use in patients undergoing implant-based and autologous tissue breast reconstructions.

Methods/Technique: We conducted a retrospective study using TriNetX, a federated research network containing deidentified aggregate data from more than ninety million patients. The analysis was completed using CPT codes to identify patients undergoing either implant-based or autologous tissue breast reconstruction. The two groups were further stratified based on active ICD-9 and ICD-10 diagnostic codes at the time of surgery: 1) patients with a diagnosis of cannabis use only and 2) patients with a diagnosis of tobacco use only. Patients with diagnoses of both cannabis and tobacco use were excluded. A logistic regression analysis was performed to determine an association between pre-operative diagnosis of tobacco or cannabis use and postoperative complications within 60 days following implant-based or autologous breast tissue. All patient cohorts were compared to patients who had no cannabis or tobacco use. Statistical significance was defined as a P-value less than 0.5 in all analyses.

Results/Complications: A total of 41,118 patients underwent implant-based breast reconstruction and 28,341 patients had breast reconstruction with autologous tissue. Of those, 177 patients in the implant group and 146 patients in the autologous group had an active diagnosis of cannabis use, respectively, while 868 patients in the implant group and 475 patients in the autologous group had a diagnosis of tobacco use only, respectively. Relative to the control cohort, implant reconstruction patients in the cannabis only cohort had a significantly increased risk of developing postoperative infection (OR: 2.41) and required debridement (OR: 2.80), while autologous reconstruction patients in the cannabis only cohort had significantly increased risk of developing postoperative infection (OR: 1.78) and required incision and drainage (OR: 1.96). When compared to the control cohort, patients who underwent implant reconstruction and used cannabis had a higher risk of developing post-operative infection (OR: 2.41) and required debridement (OR: 2.80) than patients that used tobacco (Post-Operative Infection OR: 1.94, Debridement OR: 2.02). (Table 1).

Conclusion: This is the first study to investigate the associations between cannabis use and postoperative complications in patients undergoing breast reconstruction procedures. By providing a comprehensive investigation of the post-operative risks of cannabis use, our results suggest that cannabis increases the risk of wound-healing complications. Surgeons should discuss the implications of the use of cannabis and tobacco with this patient population and encourage them to avoid the use of such products in the perioperative period to minimize the risk of complications. Further studies are needed to determine the actual effects of cannabis to postoperative complications and the timing required to avoid it prior to surgical intervention.