Preoperative Cannabis Use and Ankle ORIF Outcomes: Higher Risks of Infection, Nonunion, and Reoperation

Q: How was cannabis exposure categorized in the study?

Patients undergoing ankle ORIF for rotational ankle fractures were identified using standardized CPT codes and stratified by preoperative active cannabis use.

Q: What outcomes showed significantly increased risks after 90 days?

At 90 days postoperatively, cannabis use was associated with higher risks of postoperative infection, wound dehiscence, and inpatient readmissions.

Q: Which long-term surgical outcomes were increased at 3 years?

At 3 years, cannabis use was linked to increased risks of nonunion and reoperation.

Sep 28, 2026

Uploaded by Chumphorn

Preoperative cannabis use is evaluated for its relationship with perioperative outcomes after ankle fracture fixation using open reduction and internal fixation (ORIF). A retrospective cohort study draws from a nationally representative research database, identifying rotational ankle fracture patients via CPT codes and stratifying by preoperative active cannabis use. Propensity score matching controls 27 confounders, with outcomes tracked at 90 days and 6 months medically and at 3 years surgically. After matching, cannabis use increases infection, wound dehiscence, readmissions, sepsis, hardware infection, nonunion, and reoperation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Abstract

Background

Methods

Results

Conclusion

Level of Evidence

Introduction

Risk factors and clinical context

Trends in cannabis use

Article Preoperative Cannabis Use and Ankle ORIF Outcomes: Higher Risks of Infection, Nonunion, and Reoperation Foot & Ankle International® 2026, Vol. 47(1) 43–51 © The Author(s) 2025 Article reuse guidelines: [sagepub.com/journals-permissions](sagepub.com/journals-permissions)[ ](sagepub.com/journals-permissions)[DOI: 10.1177/10711007251385971](DOI: 10.1177/10711007251385971)[ ](DOI: 10.1177/10711007251385971)[journals.sagepub.com/home/fai](journals.sagepub.com/home/fai) Sri Tummala, BS 1,2, Brandon A. Wood, MS3, Mehul M. Mittal, BBA3, Senthil N. Sambandam, MD 1, and Dane K. Wukich, MD 1,4 Abstract Background: With the widespread legalization and rising prevalence of cannabis use, understanding its impact on perioperative outcomes has become clinically critical. Although recent orthopaedic research has examined cannabis-related risks following various procedures, its implications following surgical fixation of ankle fractures remain unexplored. Given the increasing incidence and complexity of ankle fractures, clarifying these risks is essential for effective perioperative management and patient counseling. Methods: A retrospective cohort analysis was conducted using a nationally representative research database. Patients undergoing open reduction and internal fixation (ORIF) for rotational ankle fractures were identified using standardized Current Procedural Terminology (CPT) codes and stratified by preoperative active cannabis use. Propensity score matching (PSM) was used to control for 27 demographic and clinical confounders; data were drawn from the TriNetX Research Network; postmatch balance is reported. Outcomes assessed included medical complications and health care utilization at 90 days and 6 months, and surgical outcomes at 3 years postoperatively. Relative risks (RRs) with 95% confidence intervals were calculated. To account for multiple testing across 34 outcomes, a Bonferroni correction was applied, with statistical significance defined as P < .0015. Results: After PSM, 3126 matched pairs were included in the analysis. At 90 days postoperatively, cannabis use was significantly associated with increased risks of postoperative infection (RR = 1.696, 95% CI 1.230-2.337, P < .001), wound dehiscence (RR = 1.781, 95% CI 1.268-2.502, P < .001), and inpatient readmissions (RR = 1.724, 95% CI 1.221-2.435, P < .001). These associations persisted at 6 months, including elevated risks of postoperative infection (RR = 1.745, 95% CI 1.304-2.337, P < .001), sepsis (RR = 2.847, 95% CI 1.477-5.488, P < .001), and hardware infection (RR = 1.944, 95% CI 1.291-2.929, P < .001). At 3 years, the cannabis-use cohort was associated with significantly increased risks of nonunion (RR = 2.308, 95% CI 1.207-4.413, P < .001) and reoperation (RR = 2.168, 95% CI 1.353-3.475, P < .001). No significant differences were observed for other measured outcomes following Bonferroni adjustment. Conclusion: Preoperative cannabis use is associated with significantly increased complications following ankle ORIF, notably systemic and hardware infections, nonunion, and reoperation. These findings support recognizing cannabis use asa potentially modifiable perioperative risk factor, akin to tobacco use, underscoring the importance of targeted counseling and strategies aimed at optimizing surgical and patient outcomes. Level of Evidence: Level III, case control-study or retrospective cohort study. Keywords: Cannabis, Ankle Fracture, Open Reduction Internal Fixation, ORIF, Nonunion, Reoperation, Outcomes, Risk Factors Introduction Ankle fractures represent a substantial and increasing public health concern in developed nations, currently occurring atan incidence of approximately 150 per 100 000 individuals annually. 13,30,31 The surgical management of these fractures may be complicated by postoperative issues such as infections, delayed wound healing, and implant-related issues. 1,8,22 Identifying and managing modifiable perioperativ

FAQs

How was cannabis exposure categorized in the study?

Patients undergoing ankle ORIF for rotational ankle fractures were identified using standardized CPT codes and stratified by preoperative active cannabis use.

What outcomes showed significantly increased risks after 90 days?

At 90 days postoperatively, cannabis use was associated with higher risks of postoperative infection, wound dehiscence, and inpatient readmissions.

Which long-term surgical outcomes were increased at 3 years?

At 3 years, cannabis use was linked to increased risks of nonunion and reoperation.

Sep 28, 2026

Uploaded by Chumphorn