Preoperative cannabis use leads to worse outcomes after surgery for gastroparesis, indicating patient selection is crucial.

• Cannabis users had a higher reintervention rate within 90 days (9.3% vs 1.2%) and more inpatient admissions (32.4% vs 23.7%).
• Over 5 years, they faced higher hospital admission rates (59.3% vs 41.0%) and showed less outpatient engagement (54.6% attended follow-up).

Surgeons should consider closer follow-up for cannabis users post-surgery due to their increased symptom burden and healthcare needs.