Cannabis Use and Prolonged Opioid Utilization After Head and Neck Free Flap Reconstructive Surgery

GOAL: This study investigates the risk of prolonged postoperative opioid use and functional outcomes of free flap reconstruction in head and neck cancer patients with a history of cannabis use. METHODS: Patients undergoing head and neck free flap reconstruction (2005-2025) were identified using the TriNetX database and stratified by cannabis use. Cohorts were propensity score-matched for demographics, substance use, and tumor characteristics. The primary outcome was postoperative opioid use at 3-12 months; secondary outcomes included tracheostomy and gastrostomy dependence. Multivariable Cox regression adjusted for behavioral health comorbidities. RESULTS: After matching, each cohort (cannabis users and non-users) consisted of 532 patients. Cannabis users were more likely to be gastrostomy tube dependent at 3 months (RR: 1.56, 95% CI: [1.19-2.04]). Preoperative cannabis use increased the risk of prolonged postoperative opioid use at 3-6 months (RR: 1.19, 95% CI: [1.05-1.36]), 6-9 months (RR: 1.35, 95% CI: [1.13-1.62]), and 9-12 months (RR: 1.26, 95% CI: [1.04-1.52]). There was no significant difference in tracheostomy dependence at any time point. In adjusted Cox regression analysis, perioperative cannabis persisted as independently associated with prolonged opioid use (HR: 1.42, 90% CI: [1.14, 1.76]). CONCLUSION: Head and neck cancer patients with a history of cannabis use demonstrate increased risk of prolonged opioid use after free flap reconstructive surgery even after adjusting for behavioral health comorbidities, highlighting the need for targeted pain management strategies and closer postoperative monitoring in this patient population.