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   WEDNESDAY, Oct. 19, 2022 (HealthDay News) -- Surgeons have long advised   
   patients to stop smoking cigarettes for several weeks before their   
   operations to lower the risk of complications. But what about weed?   
      
   New research has found reason for worry: Marijuana users had higher   
   infection rates after minimally invasive knee and shoulder procedures.   
   Patients also had higher rates of deep vein thrombosis (DVT) or   
   potentially dangerous blood clots, though those risks were not   
   statistically significant.   
      
   “We had a fairly large number of patients who were using it for various   
   reasons, whether it was medical or non-medical,” explained study author   
   Dr. Jason Strelzow, an assistant professor of orthopaedic surgery at the   
   University of Chicago.   
      
   “There was really nothing out there to guide us in terms of whether we   
   should be advising patients to avoid the use of it around the time of   
   their operation or not,” he said.   
      
   What the researchers found suggests guidance is sorely needed.   
      
   Patients with marijuana dependence who had shoulder procedures had   
   infection rates that increased from 0.7% to 1.7%, and DVT rates that   
   increased from 0.2% to 0.4%. For those having knee procedures, the rates   
   increased from just over 1% to 2.6% for infection and from 0.2% to 0.3%   
   for DVT. While researchers also looked at rates of pulmonary embolism (a   
   clot that travels to the lungs) for both types of surgeries, those stayed   
   the same.   
      
   “The worry about things like smoking is really surrounding the nicotine   
   and the effect of nicotine on blood vessels, and the effect of nicotine on   
   the ability for wounds to heal, and we didn't think we'd see the same   
   thing with marijuana,” Strelzow said. The increased risk they found “was a   
   little bit of a shock to us, to be honest,” he noted.   
      
   In the study, the researchers used a national insurance claims database,   
   identifying more than 1.1 million knee patients and nearly 748,000   
   shoulder patients. Nearly 22,000 of the patients had been diagnosed with   
   marijuana dependence.   
      
   While past studies on marijuana have looked at its impacts on pain   
   management or heart risk, its post-surgical impact wasn't clear.   
      
   But even a simple infection can lead to the need for antibiotics, repeat   
   doctors' visits and continued monitoring, Strelzow said.   
      
   “On the other end of the spectrum, if you have a deep infection at the   
   time of an operation, that can lead to failure of the operation, the need   
   for repeat revision operations, and sometimes you actually can't cure   
   those deep infections to the point where patients are on lifelong   
   antibiotics and they have really lost the advantage of having whatever   
   operation they were having in the first place,” Strelzow added.   
      
   Doctors are now trying to understand what it is about marijuana that might   
   cause these problems.   
      
   Cannabinoids, one of the active ingredients in marijuana, do appear to   
   interact with platelets, which allow blood to clot. And cells in the blood   
   known as fibroblasts may interact with cannabinoids and interfere with the   
   process of bone and tissue healing, Strelzow suggested.   
      
   “I think there's still a lot to be understood in that realm, but certainly   
   the basic science would point to the fact that the cannabinoid itself, the   
   active ingredient, likely has a role. Much like any medication that we   
   take, it can have interactions that are unwanted consequences,” Strelzow   
   said.   
      
   The researchers would now like to study marijuana's impact on bone,   
   Strelzow said. Subsequent studies could also look at dose response and how   
   long weed has an impact.   
      
   The study raises new questions, said Dr. Alan Reznik, an orthopaedic   
   surgeon specializing in sports medicine, and chief medical officer of   
   Connecticut Orthopaedics and member of the American Academy of Orthopaedic   
   Surgeons.   
      
   “I think the evidence is pretty good that there is an increased risk,”   
   Reznik said, but the association does not prove a cause-and-effect   
   relationship.   
      
   And in terms of incidence, the number of those with increased risk of   
   infection is still low, Reznik noted.   
      
   What can doctors do to guard against possible complications in their   
   patients who use marijuana?   
      
      
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