Roux-en-Y gastric bypass: the impact of tobacco nicotine, nontobacco nicotine, and marijuana use on postoperative outcomes
- Journal
- Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Q1)
- Published
- 11 August 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Pooja Enagala, Joshua Wang, Zeyanna Dhalla, Chris Hsu, Sarah Samreen, Lauren McTaggart
- PMID
- 42772981
- DOI
- 10.1016/j.soard.2026.08.011
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (paper of the day, 23 September 2026): RYGB outcomes with nicotine, marijuana use
Abstract
BACKGROUND: Nontobacco nicotine products and cannabis use are increasingly prevalent, yet their effects on outcomes following Roux-en-Y gastric bypass (RYGB) remain poorly understood. OBJECTIVES: This study evaluates postoperative complications among patients undergoing RYGB using tobacco nicotine, nontobacco nicotine, or marijuana compared with nonusers. SETTING: United States. METHODS: This retrospective cohort study was conducted using the TriNetX Research Network. Adults (>18 years) undergoing RYGB were stratified into 4 propensity-matched cohorts based on documented preoperative substance use within 90 days of surgery: tobacco nicotine, nontobacco nicotine, marijuana, and nonusers. One-year outcomes included infection, readmission, seroma, anastomotic leak, deep vein thrombosis, internal hernia, marginal ulcer, and nutritional deficiencies. Risk ratios (RRs), 95% confidence intervals, and P values (P < .05) were calculated. RESULTS: Tobacco nicotine users showed increased readmission (RR 1.29), internal hernia (RR 1.29), marginal ulcer (RR 1.69), and nutritional deficiency (RR 1.04), with fewer anastomotic leaks (RR .65). Nontobacco nicotine users showed increases in readmission (RR 1.29), internal hernia (RR 1.30), and marginal ulcer (RR 1.57), with reduced leaks (RR .71). Marijuana users had increased marginal ulcers (RR 1.74), but no significant differences in readmission. No clinically meaningful differences were observed between nicotine groups or between marijuana and nicotine users. CONCLUSIONS: Tobacco nicotine, nontobacco nicotine, and marijuana use all increased morbidity across several markers, suggesting that various forms of substance use impact postoperative complications. These findings highlight the need for umbrella preoperative cessation recommendations and prospective studies on how nicotine and cannabis influence postoperative outcomes.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.