Evidence map›Paper›PMID 42236808›Full record

ArticleScientific reports2026

Cannabis use increases surgical, medical, and psychosocial complications after lower extremity fracture fixation and shows compounded risk with concurrent nicotine use.

Christopher D Hamad, Michelle Nwufo, Joshua Wiener, Timothy Liu, Thomas E Olson, Paul Walker, Soroush Shahamatdar, Nora A Galoustian, Nick Yusin, Autreen Golzar and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Scientific reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors.

Christopher D HamadDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA. chamad@mednet.ucla.edu.
Michelle NwufoDavid Geffen School of Medicine at UCLA, 1225 15th Street - Suite 3144B, Santa Monica, Los Angeles, CA, 90404, USA.
Joshua WienerDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.
Timothy LiuDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.
Thomas E OlsonDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.
Paul WalkerDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.
Soroush ShahamatdarDavid Geffen School of Medicine at UCLA, 1225 15th Street - Suite 3144B, Santa Monica, Los Angeles, CA, 90404, USA.
Nora A GaloustianDavid Geffen School of Medicine at UCLA, 1225 15th Street - Suite 3144B, Santa Monica, Los Angeles, CA, 90404, USA.
Nick YusinUniversity of Southern California, Los Angeles, CA, USA.
Autreen GolzarDavid Geffen School of Medicine at UCLA, 1225 15th Street - Suite 3144B, Santa Monica, Los Angeles, CA, 90404, USA.
David C KaelberPopulation and Quantitative Health Sciences, Case Western Reserve University and the Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, OH, USA.
Nicholas M BernthalDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.
Christopher LeeDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.
William L SheppardDepartment of Orthopaedic Surgery, University of California, Los Angeles, CA, USA.

Funding

Clinical and Translational Science Collaborative of Northern Ohio, Catalyzing Linkages to Equity in Health (CLE Health)UM1TR004528 · NCATS · CASE WESTERN RESERVE UNIVERSITY · PI GRACE A MCCOMSEY · 2023 to 2026
$32.1M
Regenerative Musculoskeletal Medicine Training ProgramT32AR059033 · NIAMS · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI John S Adams, Nicholas M. Bernthal · 2011 to 2026
$4.8M
NCATS NIH HHS UM1 TR004528NIAMS NIH HHS T32 AR059033
6 · The paper itself

Abstract

Cannabis use is rapidly increasing in the United States, yet its perioperative implications remain poorly understood, particularly in trauma populations. Despite expanding legalization, the perioperative effects of cannabis on surgical outcomes remain uncertain. This retrospective cohort study used electronic health record data to evaluate the association between cannabis use, with and without concurrent nicotine exposure, and postoperative outcomes following orthopedic lower extremity trauma fixation. We conducted a retrospective cohort study using the TriNetX Research Network, a global federated electronic health record platform that aggregates de-identified clinical data from more than 90 health systems. Adult patients who underwent surgical fixation of lower extremity fractures between 2015 and 2023 were stratified into four cohorts: cannabis only users (n = 2421), nicotine only users (n = 36,966), concurrent users (n = 2338), and non-users. Primary outcomes included surgical and medical postoperative complications; secondary outcomes included psychosocial outcomes and coagulation parameters (PT, aPTT). Binary outcomes were evaluated using absolute risk differences, risk ratios (RR), and 95% confidence intervals (CIs). Continuous variables were compared using independent samples t-tests assuming unequal variances. Cannabis-only users demonstrated higher rates of deep implant infection, nonunion or malunion, reoperation, transfusion, readmission, anxiety, and depression compared with matched non-users. Nicotine-only users showed higher rates of wound complications, infection, nonunion or malunion, reoperation, transfusion, pneumonia, myocardial infarction, death, opioid use, chronic pain, readmission, anxiety, and depression compared with matched non-users. Concurrent cannabis-and-nicotine users had higher rates of superficial wound infection, deep implant infection, reoperation, amputation, transfusion, pneumonia, respiratory failure, opioid use, chronic pain, readmission, and anxiety compared with matched cannabis-only users. Coagulation measures were not consistently different across exposure groups. Cannabis use was associated with surgical and psychosocial complications in this large retrospective cohort. Nicotine use was associated with broader adverse effects, and concurrent cannabis-and-nicotine exposure was associated with compounded perioperative risk. These findings support further prospective evaluation of perioperative substance use screening and counseling strategies in surgical populations. Prospective studies quantifying cannabis exposure are needed to define dose-response effects and mechanisms.

Indexed as

Fracture FixationFractures, BoneLower ExtremityMarijuana UseNicotinePostoperative ComplicationsAdultAgedFemaleHumansMaleMiddle AgedRetrospective StudiesRisk FactorsNicotineCannabisLower extremity fracturesNicotineOrthopaedic traumaPostoperative complicationsPropensity score matching

Identifiers

PMID42236808
PMCPMC13470265

What OpenQuestion holds

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Read underepoch 390

Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.