• Wendy Suhre, Vikas O'Reilly-Shah, and Wil Van Cleve.
• Department of Anesthesiology and Pain Medicine, University of Washington, Box 356540, 1959 NE Pacific St, Seattle, WA, 98195, USA. suhre@uw.edu.
• BMC Anesthesiol. 2020 May 18; 20 (1): 115115.

BackgroundCannabis legalization may contribute to an increased frequency of chronic use among patients presenting for surgery. At present, it is unknown whether chronic cannabis use modifies the risk of postoperative nausea and vomiting (PONV).MethodsThis study was a retrospective cohort study conducted at 2 academic medical centers. Twenty-seven thousand three hundred eighty-eight adult ASA 1-3 patients having general anesthesia for non-obstetric, non-cardiac procedures and receiving postoperative care in the Post Anesthesia Care Unit (PACU) were analyzed in the main dataset, and 16,245 patients in the external validation dataset. The main predictor was patient reported use of cannabis in any form collected during pre-anesthesia evaluation and recorded in the chart. The primary outcome was documented PONV of any severity prior to PACU discharge, including administration of rescue medications in PACU. Relevant clinical covariates (risk factors for PONV, surgical characteristics, administered prophylactic antiemetic drugs) were also recorded.Results10.0% of patients in the analytic dataset endorsed chronic cannabis use. Using Bayesian Additive Regression Trees (BART), we estimated that the relative risk for PONV associated with daily cannabis use was 1.19 (95 CI% 1.00-1.45). The absolute marginal increase in risk of PONV associated with daily cannabis use was 3.3% (95% CI 0.4-6.4%). We observed a lesser association between current, non-daily use of cannabis (RR 1.07, 95% CI 0.94-1.21). An internal validation analysis conducted using propensity score adjustment and Bayesian logistic modeling indicated a similar size and magnitude of the association between cannabis use and PONV (OR 1.15, 90% CI 0.98-1.33). As an external validation, we used data from another hospital in our care system to create an independent model that demonstrated essentially identical associations between cannabis use and PONV.ConclusionsCannabis use is associated with an increased relative risk and a small increase in the marginal probability of PONV.

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