eP343 - Cannabis Use on the Rise: Impact of Cannabis Use on Post-Operative Outcomes in Colon Surgery

Purpose/Background: As cannabis continues to become legalized throughout the United States (U.S.) at an increasing rate, we must continue to explore such exposures that can pose risks to our patient populations. Cannabis is comprised of 2 main components, Tetrahydrocannabinol (THC) and Cannabidiol (CBD), both able to bind to cannabinoid receptors which are located throughout the body with resulting effects on pain and the gastrointestinal, immune, and cardiopulmonary systems. With approximately 17% of the U.S. population reporting cannabis use, it is essential to study its implication on surgical outcomes. In surgical patients, cannabis use has been linked to the need for a significantly higher induction dose of propofol when compared to cannabis nonusers. Further, cannabis use is associated with increased risk of cardiovascular events including myocardial infarction, atrial flutter, atrial fibrillation, premature ventricular contraction, and in some cases bradycardia and atrioventricular block. The respiratory effects of cannabis use include epithelial damage, goblet cell hyperplasia, and increased mucosal secretions.

There is a deficit in research exploring the effects of cannabis use and its effects on perioperative outcomes in patients undergoing colon surgery. This study aims to explore the relationship between cannabis use and acute respiratory event risk on the day of surgery, as well as other 30-day outcomes. Based on the existing literature, we hypothesized that cannabis users would be at increased risk for these complications.Methods/Interventions: A retrospective study of the TriNetX global research network was performed. In total, 270 patients undergoing colon surgery (partial or total colectomy) at 55 institutions were included. Propensity score matching was performed to generate matched cohorts of cannabis users (CU, n=135) and nonusers (NU, n=135), based on age, sex, race/ethnicity, and medical comorbidities (diabetes, obesity, gastro-esophageal reflux disease, and sleep apnea). The risk of acute respiratory event on the day of surgery and adverse outcomes within 30 days were compared between the two cohorts using univariate statistics.Results/Outcomes: Cannabis users were more likely to have an acute respiratory event on the day of surgery compared to nonusers (CU: 27.4% vs. NU: 9.6%, Risk Ratio [RR]: 2.31, 95% Confidence Interval [CI]:1.35-3.95, p < 0.001). During the 30-day postoperative period, are cannabis users were more likely to experience respiratory failure (CU: 23.7% vs. NU: 7.4%, RR: 3.20, 95% CI: 1.64-6.3, p=0.002) and abdominal pain (CU: 29.6% vs. NU: 19.3%, RR: 1.54, 95% CI: 1.0-2.4, p=0.047) when compared to nonusers. There was no difference in risk of ileus/obstruction, nausea and vomiting, shock, wound infection, deep vein thrombosis, or cardiac arrest between the cannabis users and nonusers within the 30-day period.Conclusion/

Discussion: This study suggests an association between cannabis use and increased risk for respiratory events on the day of surgery, and respiratory failure and prolonged abdominal pain within 30-days postoperatively. With the field of colorectal surgery having optimized surgical outcomes with the use of enhanced recovery pathways, it is essential to continue updating these protocols to adapt to the ever-changing societal trends.