Comprehensive analysis of cannabis use and dependence in the setting of total abdominal hysterectomy

Abstract Background Widespread legalization of cannabis has been associated with an increased prevalence of cannabis use and dependence (CUD) among surgical patients. This study examines the demographic characteristics, comorbidities, and inpatient outcomes of patients with CUD undergoing total abdominal hysterectomy (TAH). Methods retrospective cohort study utilized the National Inpatient Sample (2016–2021) to identify patients undergoing TAH. Patients were stratified into CUD and non-CUD cohorts. Demographics, comorbidities, in-hospital complications, and economic outcomes were compared using t -tests and chi-square analyses. Propensity score matching was performed to assess postoperative complications. Results Among 557,055 TAH procedures, 0.50% involved patients with CUD. Compared with non-CUD patients, those with CUD were younger (49 vs. 53 years), more often Black (38.7% vs. 23.8%) or Native American (0.5% vs. 0.4%), and more frequently insured by Medicaid (43.1% vs. 15.2%). Patients with CUD experienced longer hospitalizations (4.6 vs. 3.5 days) and higher total charges ($72,078 vs. $62,610). They also had higher rates of comorbid substance use, including alcoholism (7.3% vs. 0.5%), opioid use disorder (3.4% vs. 0.2%), and tobacco use disorder (50.8% vs. 9.7%), as well as anxiety (23.9% vs. 11.5%), depression (16.6% vs. 8.8%). After propensity score matching, CUD was not associated with increased risk of postoperative complications. Conclusion As cannabis use rises, understanding the demographic and clinical profile of surgical patients with CUD is increasingly important. Recognition of CUD in patients undergoing hysterectomy may support more individualized perioperative planning, equitable screening practices, and optimized pain management strategies.