# Cannabis and Nicotine Use Linked to Adverse Surgical and Psychosocial Outcomes > **Author:** Benjamin Caplan, MD (ABFM Board Certified, MA Lic. #240562, NPI: 1962722637) > **Publisher:** CED Clinic (https://cedclinic.com) > **Canonical URL:** https://cedclinic.com/cannabis-perioperative-pain-complications-surgical-outcomes/ > **Published:** 2026-03-26T00:07:33-04:00 | **Last Modified / Clinically Audited:** 2026-09-28T10:38:56-04:00 > **Clinical Summary:** Explore cannabis perioperative pain complications and their impact on surgical, medical, and psychosocial outcomes after upper extremity fracture fixation. --- CED Clinical Relevance  #90High Clinical Relevance  Strong evidence or policy relevance with direct clinical implications. 🔬 Evidence Watch  |  CED Clinic SurgeryCannabisPerioperativePainComplications Journal Journal of orthopaedic surgery and research Study Type Cohort Population Human participants Why This Matters This large cohort study provides the first comprehensive analysis of cannabis-specific perioperative risks in orthopedic trauma, addressing a critical knowledge gap as [cannabis use](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/) becomes increasingly prevalent. Understanding these risks is essential for informed surgical consent and perioperative planning when cessation may not be realistic. Clinical Summary This retrospective cohort study analyzed 16,112 adult patients with upper extremity fractures requiring surgical fixation from 2015-2023, comparing outcomes across cannabis-only, nicotine-only, concurrent users, and matched non-users. The study found both cannabis and nicotine use independently associated with increased surgical complications, medical complications, and new postoperative psychosocial diagnoses including anxiety, depression, opioid use disorder, and [chronic pain](https://cedclinic.com/cannabinoids-pain-management-opioid-alternative/). Propensity score matching was used to control for confounders, though residual confounding remains a limitation in this observational design. Dr. Caplan’s Take “This data confirms what many of us have observed clinically – [cannabis use](https://cedclinic.com/cannabis-cardiovascular-health-insights-2024/) appears to carry distinct perioperative risks beyond those of tobacco. The association with increased [chronic pain](https://cedclinic.com/cannabinoids-pain-management-opioid-alternative/) and opioid use disorder is particularly concerning and warrants careful preoperative counseling.” Clinical Perspective 🧠 Clinicians should incorporate cannabis use history into preoperative [risk assessment](https://cedclinic.com/ethical-legal-dilemmas-cannabis-use/) and surgical consent discussions. Patients should be counseled about increased risks of complications and chronic pain syndromes, while recognizing that acute cessation before trauma surgery is often not feasible and cessation strategies should focus on the postoperative period. 💬 Join the Conversation Have a question about how this applies to your situation? [Ask Dr. Caplan →](https://benjamincaplan.com/ask-dr-caplan) Want to discuss this topic with other patients and caregivers? [Join the forum discussion →](https://cedclinic.com/interact/discussion-forums/) Have thoughts on this? Share it: [𝕏 Share on X](https://twitter.com/intent/tweet?text=Just%20read%20this%20on%20CEDclinic.com%3A%20Cannabis%20and%20nicotine%20use%20are%20independently%20associated%20with%20adverse%20surgical%2C%20me...%20%40drcaplan&url=https%3A//pubmed.ncbi.nlm.nih.gov/41555366/)[in Share on LinkedIn](https://www.linkedin.com/sharing/share-offsite/?url=https%3A//pubmed.ncbi.nlm.nih.gov/41555366/)[🦥 Share on BlueSky](https://bsky.app/intent/compose?text=Just%20read%20this%3A%20Cannabis%20and%20nicotine%20use%20are%20independently%20associated%20with%20adverse%20surgical%2C%20me...%20--%20via%20%40drcaplan.bsky.social%20https%3A//pubmed.ncbi.nlm.nih.gov/41555366/)[📷 Follow on Instagram](https://www.instagram.com/drbenjamincaplan/)[📝 Read more on Substack](https://substack.com/@doctorapproved)[🔔 Subscribe via RSS](https://cedclinic.com/category/cannabis-news/feed/) 📰 Source: [https://pubmed.ncbi.nlm.nih.gov/41555366/](https://pubmed.ncbi.nlm.nih.gov/41555366/) Table of Contents - [FAQ](#FAQ)[Should I advise cannabis users to stop before upper extremity fracture surgery?](#Should_I_advise_cannabis_users_to_stop_before_upper_extremity_fracture_surgery) - [Are the risks from cannabis use as significant as those from nicotine use?](#Are_the_risks_from_cannabis_use_as_significant_as_those_from_nicotine_use) - [What specific complications should I watch for in cannabis-using patients after upper extremity surgery?](#What_specific_complications_should_I_watch_for_in_cannabis-using_patients_after_upper_extremity_surgery) - [How should cannabis use affect my perioperative planning and patient counseling?](#How_should_cannabis_use_affect_my_perioperative_planning_and_patient_counseling) - [Does cannabis use affect coagulation parameters that could impact surgical planning?](#Does_cannabis_use_affect_coagulation_parameters_that_could_impact_surgical_planning) - [Related](#Related) ## FAQ #### Should I advise cannabis users to stop before upper extremity fracture surgery? This study demonstrates that cannabis use is independently associated with increased surgical, medical, and psychosocial complications following upper extremity fracture fixation. While cessation may not always be feasible in trauma settings, patients should be counseled about these elevated risks and monitored more closely perioperatively. #### Are the risks from cannabis use as significant as those from nicotine use? Yes, this research shows that cannabis and nicotine use are independently associated with adverse outcomes, meaning both substances carry distinct risks. Patients using both substances concurrently face compounded risks and require the most intensive perioperative management and monitoring. #### What specific complications should I watch for in cannabis-using patients after upper extremity surgery? Cannabis users showed increased rates of surgical complications, medical complications, and new postoperative psychosocial diagnoses including anxiety, depression, opioid use disorder, and chronic pain. These patients require enhanced surveillance for both physical and mental health complications during recovery. #### How should cannabis use affect my perioperative planning and patient counseling? Cannabis users should receive comprehensive preoperative counseling about increased complication risks and may benefit from enhanced perioperative support services. Consider involving mental health resources early and developing more intensive [pain management](https://cedclinic.com/cbd-cbg-topicals-for-eczema/) strategies given the higher risk of chronic pain and opioid use disorder. #### Does cannabis use affect coagulation parameters that could impact surgical planning? The study evaluated coagulation parameters as secondary outcomes in cannabis users undergoing upper extremity fracture fixation. While specific coagulation results aren’t detailed in the summary, this represents an important consideration for surgical planning that warrants preoperative assessment in cannabis-using patients. {“@context”: “https://schema.org”, “@type”: “ScholarlyArticle”, “headline”: “Cannabis and nicotine use are independently associated with adverse surgical, medical, and psychosocial outcomes following upper extremity fracture fixation.”, “url”: “https://pubmed.ncbi.nlm.nih.gov/41555366/”, “about”: “journal orthopaedic surgery research cohort cannabis”, “isPartOf”: “Journal of orthopaedic surgery and research”} [https://cedclinic.com/contact/](https://cedclinic.com/contact/) Physician-Led, Whole-Person Care A doctor who takes the time to truly understand you. Personal care that starts with listening and is guided by experience and ingenuity. Health, Longevity, Wellness One-on-One Cannabis Guidance Metabolic Balance [Leave a Message](https://cedclinic.com/contact/) [Metabolic Care](https://cedclinic.com/metabolic/metabolic-how-it-works/) [Medical Consulting](https://cedclinic.com/book/) [Cannabis Care](https://cedclinic.com/book/) [https://cedclinic.com/contact/](https://cedclinic.com/contact/) RELATED READING AT CED CLINIC Continue exploring the evidence [Impact of cannabis use disorder on risk of surgical complications following anterior cervical …](https://cedclinic.com/cannabis-use-disorder-surgical-complications-risk/) This article explores how [cannabis use disorder](https://cedclinic.com/sex-differences-cannabis-stress-reactivity-oxytocin/) influences surgical complication risks in anterior cervical procedures, highlighting important clinical considerations. [Read More](https://cedclinic.com/cannabis-use-disorder-surgical-complications-risk/) [Alcohol and Tobacco More Harmful Than Marijuana, Government Study Confirms (2026)](https://cedclinic.com/alcohol-tobacco-harm-comparison-government-study-2026/) A government study comparing harms of alcohol, tobacco, and marijuana, providing context for substance-related surgical risk assessments. [Learn More](https://cedclinic.com/alcohol-tobacco-harm-comparison-government-study-2026/) [Opioids and Cannabis: An Uncertain Combination?](https://cedclinic.com/opioid-cannabis-interactions-risks-clinical-insights/) Examines the complex interactions between opioid use and cannabis, relevant for managing postoperative pain and opioid use disorder risks. [Explore Insights](https://cedclinic.com/opioid-cannabis-interactions-risks-clinical-insights/) ### Related --- ### Verification & Medical Governance - **Lead Clinical Author:** Benjamin Caplan, MD - **Credentials:** Board Certified in Family Medicine (ABFM), Former CMO Canna Care Docs (250,000+ patients supervised), Founder & CMO CED Clinic & CED Foundation, Author of *The Doctor-Approved Cannabis Handbook* (Penguin Random House). - **Clinical Scale:** 350,000+ lifetime evaluations overseen; 81,008-patient Real-World Evidence Registry (`~/.ced_rwe_vault.db`); 125,000+ peer-reviewed study literature observatory (`http://localhost:8768/api/explorer/terminal`). - **License Verification:** Commonwealth of Massachusetts License #240562 (https://checkahealthlicense.mass.gov/). - **NPI Registry:** 1962722637 (https://npiregistry.cms.hhs.gov/provider-view/1962722637). - **Ethics & Data Privacy:** Clinical registry observations adhere strictly to HIPAA Safe Harbor de-identification (45 CFR § 164.514(b)) and criteria for secondary research exemption under 45 CFR § 46.104(d)(4).