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Open Access 21-05-2024 | Bariatric Surgery | Review

Perioperative Cannabis Use in Bariatric Patients: A Review of Outcomes and Proposed Clinical Pathway for Management

Authors: Meghan H. Maceyko, Marc Neff, Jonathan Halevy, Marguerite Dunham

Published in: Obesity Surgery | Issue 7/2024

Abstract

Legalization of marijuana has led to increased prevalence of medical and recreational cannabis use, underscoring the importance for anesthesiologists, surgeons, and perioperative physicians to understand the effects of this drug in patient care. Bariatric surgical patients represent a unique target population to understand peri-operative cannabis use and its effects as these patients undergo an extensive preoperative psychological and nutritional evaluation. Standardized guidelines on cannabis use in bariatric surgery are lacking and many clinicians remain uncertain on how to handle cannabis use in the peri-operative period. Here, we summarize the data on cannabis use in bariatric patients, specifically exploring anesthetic considerations, weight loss, complications, mortality, and psychiatric outcomes. We propose a clinical pathway to assist clinicians with perioperative decision making in bariatric patients who use marijuana.

American Society for Metabolic and Bariatric Surgery (ASMBS). Estimate of bariatric surgery numbers, 2011–2018. Published June 2018. Available at: https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers. Accessed Apr 15 2020.

Courcoulas AP, Christian NJ, Belle SH, et al. Weight change and health outcomes at 3 years after bariatric surgery among individuals with severe obesity. JAMA. 2013;310:2416–25.PubMedPubMedCentral

Mechanick JI, Apovian C, Brethauer S, et al. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures - 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis. 2020;16(2):175–247. https://doi.org/10.1016/j.soard.2019.10.025.CrossRefPubMed

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2018). National survey on drug use and health 2016 (NSDUH-2016-DS0001). Retrieved from https://datafiles.samhsa.gov/.

King WC, Chen J, Courcoulas A, et al. Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study. Surgery for obesity and related diseases. 2017;13(8):1392–1402. https://www.clinicalkey.es/playcontent/1-s2.0-S1550728917301521. https://doi.org/10.1016/j.soard.2017.03.021.

Goetze RE, Clark MM, Rakocevic DB, et al. Cannabis use and bariatric surgery psychology practice: survey and insights. Surg Obe Relat Dis. 2021;17(4):701–10. https://doi.org/10.1016/j.soard.2020.12.004.doi:10.1016/j.soard.2020.12.004 .

Shah S, Schwenk ES, Sondekoppam RV, et al. ASRA pain medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids. Reg Anesth Pain Med. 2023;48(3):97. https://doi.org/10.1136/rapm-2022-104013.CrossRefPubMed

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Pertwee RG. Cannabinoids. ; 2005:1–51. https://doi.org/10.1007/3-540-26573-2_1.

10.

Goel A, McGuinness B, Jivraj NK, et al. Cannabis use disorder and perioperative outcomes in major elective surgeries: a retrospective cohort analysis. Anesthesiology. 2020;132:625–35. https://doi.org/10.1097/ALN.0000000000003067.CrossRefPubMed

11.

Copeland-Halperin LR, Herrera-Gomez LC, LaPier JR, et al. The effects of cannabis: implications for the surgical patient. Plast Reconstr Surg Glob Open. 2021;9(3):e3448. https://doi.org/10.1097/GOX.0000000000003448.CrossRefPubMedPubMedCentral

12.

Lundstrøm LH, Møller AM, Rosenstock C, et al. High body mass index is a weak predictor for difficult and failed tracheal intubation: a cohort study of 91,332 consecutive patients scheduled for direct laryngoscopy registered in the Danish Anesthesia Database. Anesthesiology. 2009;110(2):266–74. https://doi.org/10.1097/ALN.0b013e318194cac8. (PMID: 19194154).CrossRefPubMed

13.

Damkier P, Lassen D, Christensen MMH, et al. Interaction between warfarin and cannabis. Basic Clin Pharmacol Toxicol. 2018;124(1):28. https://doi.org/10.1111/bcpt.13152.CrossRefPubMed

14.

Greger J, Bates V, Mechtler L, et al. A review of cannabis and interactions with anticoagulant and antiplatelet agents. J Clin Pharmacol. 2019;60(4):432–8. https://doi.org/10.1002/jcph.1557.CrossRefPubMed

15.

Shockcor N, Adnan SM, Siegel A, et al. Marijuana use does not affect the outcomes of bariatric surgery. Surg Endosc. 2021;35(3):1264–8. https://doi.org/10.1007/s00464-020-07497-5.CrossRefPubMed

16.

Huang EY, Broderick RC, Li JZ, et al. Weight loss outcomes are not compromised in bariatric patients using cannabis. Surg Endosc. 2023;37(3):2194–2201. https://link.springer.com/article/10.1007/s00464-022-09453-x. Accessed 15 Mar 2024

17.

Miller-Matero LR, Ross K, Depascale E, et al. Post-surgical cannabis use is associated with weight loss among individuals up to 4 years after bariatric surgery. Surg Endosc. 2023;37(8):6315. https://doi.org/10.1007/s00464-023-10126-6.CrossRefPubMed

18.

Janes LA, Hammond JW, Bonham AJ, et al. The effect of marijuana use on short-term outcomes with bariatric surgery. Surgery for obesity and related diseases. 2023. https://doi.org/10.1016/j.soard.2023.02.025.doi:10.1016/j.soard.2023.02.025.

19.

Worrest T, Malibiran CC, Welshans J et al. Marijuana use does not affect weight loss or complication rate after bariatric surgery. Surg Endosc. 2022;36(9):6931–6936. https://link.springer.com/article/10.1007/s00464-022-09038-8. Accessed 14 Jan 2024

20.

Kim DH, Lukens FJ, Ko D, et al. Incidence, burden, and predictors of 11-month readmission in patients undergoing bariatric surgery. OBES SURG. 2023;33(1):94–104. https://link.springer.com/article/10.1007/s11695-022-06343-y. Accessed 12 Jan 2024

21.

Shah RM, Patel S, Patel S, Sandhu LK, Chand B. Severe cannabis use is associated with complications and prolonged length of stay in bariatric surgery. OBES SURG. 2023;33(5):1333–1337. https://link.springer.com/article/10.1007/s11695-023-06552-z. Accessed 12 Jan 2024

22.

Li L, Wu L. Substance use after bariatric surgery: a review. Journal of psychiatric research. 2016;76:16–29. https://www.clinicalkey.es/playcontent/1-s2.0-S0022395616300085. https://doi.org/10.1016/j.jpsychires.2016.01.009

23.

Vidot DC, Prado G, De La Cruz-Munoz N et al. Postoperative marijuana use and disordered eating among bariatric surgery patients. Surgery for obesity and related diseases. 2016;12(1):171–178. https://www.clinicalkey.es/playcontent/1-s2.0-S1550728915002063. https://doi.org/10.1016/j.soard.2015.06.007

24.

Vidot DC, Deo S, Daunert S, et al. A preliminary study on the influence of cannabis and opioid use on weight loss and mental health biomarkers post-weight loss surgery. OBES SURG. 2020;30(11):4331–4338. https://link.springer.com/article/10.1007/s11695-020-04828-2. Accessed 12 Jan 2024

25.

Mcafee J, Boehnke KF, Moser SM, et al. Perioperative cannabis use: a longitudinal study of associated clinical characteristics and surgical outcomes. Reg Anesth Pain Med. 2021;46(2):137. https://doi.org/10.1136/rapm-2020-101812.CrossRefPubMed

26.

Bauer FL, Donahoo WT, Hollis HW, et al. Marijuana’s influence on pain scores, initial weight loss, and other bariatric surgical outcomes. Permanente journal. 2018;22(3):18–002. https://www.ncbi.nlm.nih.gov/pubmed/30010532. https://doi.org/10.7812/TPP/18-002

27.

Gobbi G, Atkin T, Zytynski T, et al. Association of cannabis use in adolescence and risk of depression, anxiety, and suicidality in young adulthood: a systematic review and meta-analysis. JAMA Psychiat. 2019;76(4):426–34.CrossRef

28.

Moore THM, Zammit S, Lingford-Hughes A, et al. Cannabis use and risk of psychotic or affective mental health outcomes: a systematic review. Lancet. 2007;370(9584):319–28. https://doi.org/10.1016/S0140-6736(07)61162-3.CrossRefPubMed

Title: Perioperative Cannabis Use in Bariatric Patients: A Review of Outcomes and Proposed Clinical Pathway for Management
Authors: Meghan H. Maceyko
Marc Neff
Jonathan Halevy
Marguerite Dunham
Publication date: 21-05-2024
Publisher: Springer US
Keywords: Bariatric Surgery
Bariatric Surgery
Published in: Obesity Surgery / Issue 7/2024
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI: https://doi.org/10.1007/s11695-024-07281-7

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