Evaluating the effects of recreational drug use on ruptured cerebral arteriovenous malformation presentation and in-hospital outcomes: a national inpatient sample analysis.

Background: Recent literature highlights the adverse effects of recreational marijuana on cerebrovascular pathologies and outcomes. However, its impact on arteriovenous malformation (AVM) outcomes is unknown.

Objective: To investigate the differences in AVM outcomes between marijuana users and non-users, focusing primarily on the likelihood of presenting with rupture and secondly, on the effects of other drugs on in-hospital mortality and complications.

Methods: Adult patients diagnosed with cerebral AVMs from the National Inpatient Sample were included. Use of recreational drugs, including marijuana, alcohol, opioids, hallucinogens, stimulants, and tobacco, was documented. Univariate and multivariate logistic regression analyses identified associations between drug use and AVM outcomes.

Results: A total of 46 480 patients were analyzed, with 11 580 (24.9%) presenting with rupture. Smoking was the most prevalent substance used (18 010, 38.7%), followed by alcohol (3 065, 6.6%), and cannabis (745, 1.6%). Smoking tobacco (OR=0.801; P=0.0002) and cannabis use (OR=0.613; P=0.0523) showed trends towards a protective effect against presentation with AVM rupture. Tobacco use was associated with reduced likelihood of extended length of stay (OR=0.837; P=0.0013), any complications (OR=0.860; P=0.0082), and in-hospital mortality (OR=0.590; P=0.0003). Alcohol use was linked to increased extended length of stay (OR=1.363; P=0.0033) and complications (OR=1.442; P=0.0007).

Conclusions: Stimulant use increases the likelihood of presenting with ruptured AVMs and is associated with higher mortality. Tobacco and cannabis use appear to reduce the possibility of extended hospital stays and complications.