Jakoi Andre M, Kirchner Gregory J, Lieber Alexander M, Khalsa Amrit S
Orthopedic Health of Kansas City, Kansas City, MO, USA.
Department of Orthopaedic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA.
Global Spine J. 2023 Sep;13(7):1771-1776. doi: 10.1177/21925682211049166. Epub 2022 Jan 11.
Retrospective cohort study.
The purpose of this study was to evaluate safety in lumbar spinal fusion with tranexamic acid (TXA) utilization in patients using marijuana.
This was a retrospective cohort study involving a single surgeon's cases of 1 to 4 level lumbar fusion procedures. Two hundred and ninety-four patients were followed for ninety days post-operatively. Consecutive patients were self-reported for daily marijuana use (n = 146) and compared to a similar cohort of patients who denied usage of marijuana (n = 146). Outcomes were collected, which included length of stay (LOS), estimated blood loss (EBL), post-operative myocardial infarction, seizures, deep venous thrombosis, pulmonary embolus, death, readmission, need for further surgery, infection, anaphylaxis, acute renal injury, and need for blood product transfusion.
Patients in the marijuana usage cohort had similar age (58.9 years ±12.9 vs 58.7 years ±14.8, = .903) and distribution of levels fused ( = .431) compared to the non-usage cohort. Thromboembolic events were rare in both groups (marijuana usage: 1 vs non-usage: 2). Compared to the non-usage cohort, the marijuana usage cohort had a similar average EBL (329.9 ± 298.5 mL vs 374.5 ± 363.8 mL; = .254). Multivariate regression modeling demonstrated that neither EBL (OR 1.27, 95% CI 0.64-2.49) nor need for transfusion (OR 1.56, 95% CI 0.43-5.72) varied between cohorts. The non-usage cohort had twice the risk of prolonged LOS compared to the marijuana usage cohort (OR 2.05, 95% CI 1.15-3.63).
Marijuana use should not be considered a contraindication for TXA utilization in lumbar spine surgery.
回顾性队列研究。
本研究旨在评估在使用大麻的患者中使用氨甲环酸（TXA）进行腰椎融合术的安全性。
这是一项回顾性队列研究，纳入了一位外科医生实施的1至4节段腰椎融合手术病例。294例患者术后随访90天。连续纳入自我报告每日使用大麻的患者（n = 146），并与一组否认使用大麻的类似患者队列（n = 146）进行比较。收集的结果包括住院时间（LOS）、估计失血量（EBL）、术后心肌梗死、癫痫发作、深静脉血栓形成、肺栓塞、死亡、再入院、进一步手术需求、感染、过敏反应、急性肾损伤以及血液制品输血需求。
与未使用大麻的队列相比，使用大麻的队列患者年龄相似（58.9岁±12.9 vs 58.7岁±14.8，P = 0.903），融合节段分布相似（P = 0.431）。两组血栓栓塞事件均罕见（使用大麻组：1例 vs 未使用组：2例）。与未使用大麻的队列相比，使用大麻的队列平均EBL相似（329.9 ± 298.5 mL vs 374.5 ± 363.8 mL；P = 0.254）。多因素回归模型显示，队列之间EBL（比值比1.27，95%置信区间0.64 - 2.49）和输血需求（比值比1.56，95%置信区间0.43 - 5.72）均无差异。与使用大麻的队列相比，未使用大麻的队列住院时间延长的风险是其两倍（比值比2.05，95%置信区间1.15 - 3.63）。
在腰椎手术中，不应将使用大麻视为TXA使用的禁忌证。
