Journal Article

Cannabis use and acute postoperative pain outcomes in older adults: a propensity matched retrospective cohort study

Tighe, Patrick J, Pearson, Thomas A, Seubert, Christoph N, Jugl, Sebastian, Rouhizadeh, Masoud, Sajdeya, Ruba, Dasa, Osama, Winterstein, Almut G, Zandbiglari, Kimia, Price, Catherine C, Cook, Robert L, Bai, Chen, Adiba, Farzana I, Ison, Ronald L, Mardini, Mamoun T, Gao, Hanzhi

2025

Overview

IntroductionCannabis use is increasing among older adults, but its impact on postoperative pain outcomes remains unclear in this population. We examined the association between cannabis use and postoperative pain levels and opioid doses within 24 hours of surgery.MethodsWe conducted a propensity score-matched retrospective cohort study using electronic health records data of 22 476 older surgical patients with at least 24-hour hospital stays at University of Florida Health between 2018 and 2020. Of the original cohort, 2577 patients were eligible for propensity-score matching (1:3 cannabis user: non-user). Cannabis use status was determined via natural language processing of clinical notes within 60 days of surgery and structured data. The primary outcomes were average Defense and Veterans Pain Rating Scale (DVPRS) score and total oral morphine equivalents (OME) within 24 hours of surgery.Results504 patients were included (126 cannabis users and 378 non-users). The median (IQR) age was 69 (65–72) years; 295 (58.53%) were male, and 442 (87.70%) were non-Hispanic white. Baseline characteristics were well balanced. Cannabis users had significantly higher average DVPRS scores (median (IQR): 4.68 (2.71–5.96) vs 3.88 (2.33, 5.17); difference=0.80; 95% confidence limit (CL), 0.19 to 1.36; p=0.01) and total OME (median (IQR): 42.50 (15.00–60.00) mg vs 30.00 (7.50–60.00) mg; difference=12.5 mg; 95% CL, 3.80 mg to 21.20 mg; p=0.02) than non-users within 24 hours of surgery.DiscussionThis study showed that cannabis use in older adults was associated with increased postoperative pain levels and opioid doses.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD
• Subject: Acute Pain / Acute Pain - diagnosis / Acute Pain - drug therapy / Acute Pain - epidemiology / Aged / Algorithms / Analgesics, Opioid / Analgesics, Opioid - administration & dosage / Anesthesia / Clinical outcomes / Cohort analysis / Cohort Studies / Documentation / Drug use / Electronic health records / Epidemiology / Female / Humans / Male / Marijuana / Marijuana Use - adverse effects / Marijuana Use - epidemiology / Marijuana Use - trends / Morphine / Narcotics / Natural language processing / Older people / Pain management / Pain Measurement - methods / Pain, Postoperative / Pain, Postoperative - diagnosis / Pain, Postoperative - drug therapy / Pain, Postoperative - epidemiology / Postoperative period / Propensity Score / Regional anesthesia and acute pain / Retrospective Studies / Substance use disorder / Surgery / Surgical outcomes / Treatment Outcome