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Impact of Cannabis Use on DIEP Autologous Breast Reconstruction: Analysis of 719 Patients and 1148 Flaps
John Park, Maria Escobar, Micaela Tobin, Daniela Lee, Amir-Ala Mahmoud, Benjamin Rahmani, Oluwaseun Adebagbo, James Fanning, Agustin N. Posso, Joshua Bloom, Ryan Cauley, Bernard Lee
Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, USA
IntroductionGiven recent efforts to legalize and decriminalize recreational marijuana, its use has become increasingly common in the plastic surgery patient population. Although cannabis use has generally been considered lower risk than use of other recreational substances, recent studies have suggested it may be associated with an increased surgical complication rate. The aim of our study is to (1) characterize the extent of cannabis use and (2) determine the clinical effects of cannabis use in our cohort of patients undergoing autologous breast reconstruction using deep inferior epigastric perforator (DIEP) flaps.
MethodsA retrospective study was conducted in adult patients who received autologous breast reconstruction using DIEP flaps from January 2015 to December 2023 by five plastic surgeons at our institution. Patients were divided into two groups of cannabis users and non-users. Analyses were performed using Stata statistical software 18.0.
ResultsThere were a total of 87 cannabis users (12.1%) and 632 non-users. There was a five-fold increase in the proportion of cannabis users from 2015 to 2023. Cannabis users were significantly younger (47.5 vs. 51.7 | p<0.001) and had a significantly higher BMI (30.5 vs. 28.9 | 0.012). Postoperatively, cannabis users had a significantly higher readmission rate (8.0% vs. 3.2% | p=0.035) and longer time to last abdominal drain removal (21 days vs. 17 days | p<0.001). There was trending significance of higher breast hematoma rate in cannabis users (8.0% vs. 3.8% | p=0.085). When controlling for variables, multivariable logistic regression found cannabis use as significant factor for postoperative hematoma (OR: 3.078 | CI: 1.265-7.491 | p=0.013), breast hematoma (OR: 3.098 | CI: 1.197-8.020 | p=0.020), and readmission (OR: 2.865 | 1.098-7.475 | p=0.031).
ConclusionTo our knowledge, this is the largest study examining the effects of cannabis use in patients receiving DIEP breast reconstruction. Our findings indicate that cannabis users undergoing DIEP breast reconstruction may require greater postoperative care and attention.
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