Cannabis use complicates gastroparesis surgery outcomes

Cannabis use has been associated with delayed gastric emptying and may worsen symptoms in patients with gastroparesis. However, its impact on postoperative outcomes after surgical treatment remains unclear. This study aimed to evaluate postoperative outcomes among patients with and without preoperative cannabis use undergoing surgical intervention for gastroparesis. A retrospective cohort study was conducted using the TriNetX federated electronic medical record database. Adults with gastroparesis who underwent pyloric drainage surgery or gastric stimulator placement were stratified by cannabis use (ICD-10 F12) prior to surgery. Outcomes were assessed over the first 90 days and up to 5 years postoperatively. Statistical comparisons included risk analysis, Kaplan-Meier survival, and number of instances. The study cohort consisted of 1,572 patients, including 108 (6.9%) with documented preoperative cannabis use. Patients with cannabis use were younger (39.8 vs 44.6 years, p = 0.002) and had higher rates of diabetes (56.5% vs 45.1%, p = 0.033), GERD (77.7% vs 65.1%, p = 0.014), nausea/vomiting (85.2% vs 59.4%, p < 0.001), and abdominal pain (73.1% vs 50.2%, p < 0.001). Within 90 days of surgery, cannabis users experienced higher rates of reintervention (9.3% vs 1.2%, p < 0.001) and inpatient admissions (32.4% vs 23.7%, p = 0.042), but fewer clinic visits (37.0% vs 54.5%, p < 0.001). By 5 years, cannabis users demonstrated persistently greater inpatient utilization with higher hospital admission rates (59.3% vs 41.0%, p < 0.0001) and shorter time to first admission (log-rank p < 0.001). Outpatient engagement was significantly lower, with fewer patients attending follow-up (54.6% vs 76.2%, p < 0.001), fewer total clinic encounters (8.1 vs 12.3, p = 0.045), and longer time to first clinic visit (log-rank p < 0.001). Rates of gastrectomy (0.0% vs 0.7%, p = 0.541) and late reintervention (12.0% vs 11.3%, p = 0.808) were similar between groups. Preoperative cannabis use is associated with a greater symptom burden, increased early reintervention, reduced outpatient engagement, and greater long-term healthcare utilization after surgical intervention for gastroparesis. These patients may represent a more symptomatic population and may benefit from closer follow-up to reduce readmissions.