Frank L Bauer1, William T Donahoo2, Harris W Hollis3, Adam G Tsai4, Brian J Pottorf5, Jason M Johnson6, Lori J Silveira7, Farah A Husain8. 1. At the time of this study a Surgeon in the Department of Graduate Medical Education General Surgery at Saint Joseph Hospital in Denver, CO. frank.bauer@utsouthwestern.edu. 2. At the time of this study an Attending Physician in the Department of Metabolic-Surgical Weight Management at Kaiser Permanente Colorado, and a Clinical Associate Professor of Medicine in the Division of Endocrinology, Diabetes & Metabolism at the University of Florida in Gainesville. troy.donahoo@medicine.ufl.edu. 3. At the time of this study a Senior Research Advisor in the Department of Graduate Medical Education General Surgery at Saint Joseph Hospital in Denver, CO. harriswhitt.hollisjr@sclhs.net. 4. Attending Physician in the Department of Metabolic-Surgical Weight Management at Kaiser Permanente Colorado. adam.tsai@kp.org. 5. Attending General Surgeon at Longmont United Hospital in Longmont, CO. brian.pottorf@gmail.com. 6. Program Director of the General Surgery Residency in the Department of Graduate Medical Education General Surgery at Saint Joseph Hospital in Denver, CO. jason.johnson@sclhs.net. 7. Lead Biostatistician at Telligen in West Des Moines, IA. lsilveira@telligen.com. 8. At the time of this study an Attending Physician in the Department of Metabolic-Surgical Weight Management at Kaiser Permanente Colorado, and an Assistant Professor of Surgery in the Bariatric Surgery Division in the Department of Surgery at Oregon Health and Science University in Portland. anwari23@gmail.com.
Abstract
INTRODUCTION: Pain management can be challenging following bariatric surgery, and patients with obesity tend to increase opioid use after undergoing surgery. This report quantifies marijuana (MJ) use and its relationship to pain and other surgery-related outcomes in a population from a state that has legalized MJ. METHODS: Data were collected for consecutive patients undergoing weight reduction surgeries between May 1, 2014 and July 31, 2015. Demographics, preoperative comorbidities, medications, and perioperative opioid use were analyzed. The primary outcome evaluated was inpatient opioid pain medication use quantified using natural log morphine equivalents. Secondary outcomes included percentage of total body weight loss after three months, postoperative complications, and changes in medical comorbidities. RESULTS: A total of 434 patients, among whom 36 (8.3%) reported MJ use, comprised the study population. Perioperative opioid requirements were significantly higher in the MJ-user group (natural log morphine equivalents of 3.92 vs 3.52, p = 0.0015) despite lower subjective pain scores (3.70 vs 4.24, p = 0.07). MJ use did not affect percentage of 90-day total body weight loss, development of postoperative complications, or improvement in medical comorbidities. CONCLUSION: Perioperative opioid use was significantly higher in the MJ-user group despite lower subjective pain scores. The difference in opioid requirements suggests an interaction between MJ use and opioid tolerance or pain threshold. The percentage of total body weight loss, improvement in medical comorbidity, and incidence of postoperative complications at 90-day follow-up were not affected by MJ use in this cohort analysis.
INTRODUCTION:Pain management can be challenging following bariatric surgery, and patients with obesity tend to increase opioid use after undergoing surgery. This report quantifies marijuana (MJ) use and its relationship to pain and other surgery-related outcomes in a population from a state that has legalized MJ. METHODS: Data were collected for consecutive patients undergoing weight reduction surgeries between May 1, 2014 and July 31, 2015. Demographics, preoperative comorbidities, medications, and perioperative opioid use were analyzed. The primary outcome evaluated was inpatient opioid pain medication use quantified using natural log morphine equivalents. Secondary outcomes included percentage of total body weight loss after three months, postoperative complications, and changes in medical comorbidities. RESULTS: A total of 434 patients, among whom 36 (8.3%) reported MJ use, comprised the study population. Perioperative opioid requirements were significantly higher in the MJ-user group (natural log morphine equivalents of 3.92 vs 3.52, p = 0.0015) despite lower subjective pain scores (3.70 vs 4.24, p = 0.07). MJ use did not affect percentage of 90-day total body weight loss, development of postoperative complications, or improvement in medical comorbidities. CONCLUSION: Perioperative opioid use was significantly higher in the MJ-user group despite lower subjective pain scores. The difference in opioid requirements suggests an interaction between MJ use and opioid tolerance or pain threshold. The percentage of total body weight loss, improvement in medical comorbidity, and incidence of postoperative complications at 90-day follow-up were not affected by MJ use in this cohort analysis.
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