Operative Facial Fracture Patterns in Cannabis Users: A Propensity Score-Matched Analysis

Introduction: Cannabis is the third most used recreational substance in the United States. Each year, more and more states pass legislation to legalize it for both medical and recreation use. As the prevalence of cannabis use increases, it is important to study the implications for patient care, not simply the potential interactions with wound healing, and perioperative analgesia. Facial fractures are among the most common traumatic presentations for the plastic surgeon. As such, the present study aims to characterize the operative facial fracture patterns in cannabis users. Methods: The IBM MarketScan Research Databases were queried from the years 2017 to 2021. Cohorts were identified in the inpatient dataset using International Classification for Disease, 10th Revision Procedure Coding System (ICD-10-PCS) codes for facial fracture repair procedures. The cannabis cohort was separated based on presence of ICD-10 codes pertaining to cannabis use diagnoses. The cohorts were propensity-score matched using an approximate 4:1 matching ratio. Baseline cohort demographics were reported and compared including age, gender, geographic region, employment status, insurance plan type, and fracture repair type. Multivariate regression analysis was used to determine the relationship between cannabis use and fracture repair patterns. Results: There were 104 patients in the cannabis cohort and 480 in the control cohort after propensity score matching. The cannabis group had a higher proportion of male patients (80.8%vs 69.0%, P = .016) and a lower proportion of the age range from 18 to 34 years (4.8%vs 15.8%, P = .035). Employment types were different between the 2 cohorts, with more patients in the control cohort working full time (82.3%vs 69.2%, P = .045). Cannabis users had significantly less maxillary fracture repairs (1.9%vs 19.4%, P < .001). Cannabis users also had significantly more frontal fracture repairs (1.9%vs 0.2%, P = .027) and mandibular fracture repairs (76.9%vs 63.8%, P = .010). Multivariate regression revealed that cannabis users have 1.8 times greater odds of undergoing mandibular fracture repair ( P = .020) and significantly lower odds of undergoing maxillary (OR 0.07, P = .001). Conclusion: There are significant differences in the fracture patterns for cannabis users undergoing operative management and those who do not use cannabis. While mandibular fractures were the most common fracture repair type overall, cannabis users had significantly higher odds of undergoing mandibular fracture repair. This may indicate that cannabis users are more likely to sustain injuries that require operative intervention. Further study is needed to identify the relative incidences of facial fractures among cannabis users and its implications on operative considerations.