Postoperative Outcomes After Ankle Fracture ORIF in Patients With Documented Nicotine and/or Cannabis Use: An Observational Analysis.

Abstract

Nicotine and cannabis use are increasingly relevant in surgical planning, but their effects on postoperative complications following ankle fracture open reduction and internal fixation (ORIF) remain unclear. This study evaluates associations between recent substance use and postoperative complications across multiple time points. We queried a nationwide database, TriNetX, for patients aged ≥18 years who underwent ORIF for ankle fractures between 2011 and 2023. Five independent 1:1 propensity-matched cohort analyses were performed based on substance use in the year prior to surgery: (1) dual use vs neither, (2) nicotine use vs neither, (3) cannabis use vs neither, (4) dual vs cannabis use, and (5) dual vs nicotine use. Patients with overlapping exposures were excluded from single-substance groups. Groups were 1:1 propensity score matched. Primary outcomes included 90-day wound disruption, surgical site infection (SSI), and hardware removal at 1 and 3 years. Nicotine use was associated with higher 90-day wound disruption (odds ratio [OR] 1.4 [1.2-1.6]) and SSI (OR 1.4 [1.2-1.6]) compared to nonusers. Dual users also showed increased SSI vs neither-use (OR 1.6 [1.1-2.3]), whereas wound disruption trended higher (OR 1.4 [0.99-2.0]). Cannabis use alone was not associated with higher complication rates (all <i>P</i> > .05). Compared to cannabis-only users, dual users had higher 90-day wound disruption (OR 2.0 [1.1-3.4]) and SSI (OR 1.7 [1.01-2.8]), though outcomes were similar between dual and nicotine-only users (all <i>P</i> > .05). Hardware removal rates did not differ across groups (all <i>P</i> > .05). Nicotine use was associated with increased postoperative complications after ankle fracture ORIF, whereas cannabis use alone was not. When evaluating dual substance users, complication rates were largely comparable to nicotine-only users. Further studies are needed to clarify the isolated and combined perioperative effects of cannabis and nicotine.