Heavy cannabis use may not impact heart surgery outcomes
Patients with a history of heavy cannabis use undergoing cardiac surgery do not face a heightened risk of in-hospital mortality or morbidity, according to new data published in the Journal of Cardiothoracic Surgery.[1]
“Many temporal associations between marijuana and cardiovascular disease have been described, but long-term implications are unknown,” wrote first author Krish C. Dewan, MD, a researcher Duke University School of Medicine and Rutgers Robert Wood Johnson Medical School, and colleagues. “Cardiovascular-related mortality increased by 2.3% in men and 1.3% in women in states where cannabis use was legal compared to where it was not. Cannabis use has been linked to the development arrhythmias in individuals without any other notable predisposing factors. In addition, marijuana use is also associated with acute cardiac ischemia ST-elevation myocardial infarction (STEMI), and non-STEMI. One study noted an 8% increase in the odds of developing a myocardial infarction with recreational cannabis use.”
When it comes to potential risks during major cardiac surgeries, however, there is limited research to date. To learn more, Dewan et al. explored details from nearly 850,000 hospitalizations for cardiac surgery from 2016 to 2018. Patients were undergoing isolated coronary bypass, aortic surgery or a combination of those procedures. All data came from the Nationwide Readmissions Database.
Overall, 1.4% of patients had a history of cannabis use order (CUD), loosely defined as cannabis abuse or dependence. The unmatched data show that CUD patients were actually linked to a lower mortality rate, but higher rates of stroke, pneumonia, sepsis and pulmonary embolism.
However, when comparing two matched groups of more than 6,000 patients, researchers found there were no significant differences in overall complications or in the rates of stroke, pneumonia, sepsis or pulmonary embolism. The mortality risk was actually lower for patients with a history of CUD, the authors added, and there was no difference in 90-day rehospitalization rates.
Dewan and colleagues did emphasize that their data “likely underrepresent the true number of patients who present with CUD.” In addition, miscoding may have had a similar effect.
“It will be important for future clinical studies to validate the results of this work, to further evaluate subsets of this population that may benefit from targeted screening and intervention, and to define the ideal screening and intervention protocol,” the authors wrote.
They also pointed to the fact that CUD patients were much more likely to present with a history of concomitant substance abuse—smoking cigarettes, abusing alcohol, etc. This is something care teams should work to identify and address as soon as possible.
“CUD is a marker for polysubstance abuse, which deserves prompt identification and management in the perioperative setting,” the authors concluded.
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Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.