孤立基线大麻使用对胸腰椎脊柱融合术后结局的影响：倾向评分匹配分析。
The Impact of Isolated Baseline Cannabis Use on Outcomes Following Thoracolumbar Spinal Fusion: A Propensity Score-Matched Analysis.
机构信息
Department of Orthopaedic Surgery and Rehabilitation Medicine, The State University of New York Downstate Health Sciences University, Brooklyn, New York, USA.
Spine Unit 1, Orthopedic Surgery Department, Bordeaux University Hospital, Bordeaux, France.
出版信息
Iowa Orthop J. 2022 Jun;42(1):57-62.
BACKGROUND
There is limited literature evaluating the impact of isolated cannabis use on outcomes for patients following spinal surgery. This study sought to compare 90-day complication, 90-day readmission, as well as 2-year revision rates between baseline cannabis users and non-users following thoracolumbar spinal fusion (TLF) for adult spinal deformity (ASD).
METHODS
The New York Statewide Planning and Research Cooperative System (SPARCS) database was queried between January 2009 and September 2013 to identify all patients who underwent TLF for ASD. Inclusion criteria were age ≥18 years and either minimum 90-day (for complications and readmissions) or 2-year (for revisions) follow-up surveillance. Cohorts were created and propensity score-matched based on presence or absence of isolated baseline cannabis use. Baseline demographics, hospital-related parameters, 90-day complications and readmissions, and two-year revisions were retrieved. Multivariate binary stepwise logistic regression identified independent outcome predictors.
RESULTS
704 patients were identified (n=352 each), with comparable age, sex, race, primary insurance, Charlson/Deyo scores, surgical approach, and levels fused between cohorts (all, p>0.05). Cannabis users (versus non-users) incurred lower 90-day overall and medical complication rates (2.4% vs. 4.8%, p=0.013; 2.0% vs. 4.1%, p=0.018). Cohorts had otherwise comparable complication, revision, and readmission rates (p>0.05). Baseline cannabis use was associated with a lower risk of 90-day medical complications (OR=0.47, p=0.005). Isolated baseline cannabis use was not associated with 90-day surgical complications and readmissions, or two-year revisions.
CONCLUSION
Isolated baseline cannabis use, in the absence of any other diagnosed substance abuse disorders, was not associated with increased odds of 90-day surgical complications or readmissions or two-year revisions, though its use was associated with reduced odds of 90-day medical complications when compared to non-users undergoing TLF for ASD. Further investigations are warranted to identify the physiologic mechanisms underlying these findings. .
背景
目前关于单纯吸食大麻对接受胸腰椎融合术（TLF）治疗成人脊柱畸形（ASD）患者术后结局影响的研究文献有限。本研究旨在比较基线时吸食大麻与不吸食大麻的患者在 TLF 术后 90 天内并发症、90 天内再入院率以及 2 年翻修率方面的差异。
方法
2009 年 1 月至 2013 年 9 月期间，我们通过纽约州规划与研究合作系统（SPARCS）数据库检索所有接受 TLF 治疗 ASD 的患者。纳入标准为年龄≥18 岁且具有至少 90 天（用于并发症和再入院率）或 2 年（用于翻修率）随访监测。根据基线时是否存在单纯性大麻使用，创建队列并进行倾向评分匹配。提取基线人口统计学资料、医院相关参数、90 天内并发症和再入院率以及 2 年翻修率等数据。多变量二项逐步逻辑回归确定独立的结局预测因素。
结果
共纳入 704 例患者（n=352 例），两组患者的年龄、性别、种族、主要保险、Charlson/Deyo 评分、手术入路和融合节段均具有可比性（均，p＞0.05）。与不使用者（n=352）相比，使用者（n=352）的 90 天内总体并发症和医疗并发症发生率较低（2.4%比 4.8%，p=0.013；2.0%比 4.1%，p=0.018）。两组患者的并发症、翻修和再入院率无显著差异（p＞0.05）。基线时大麻使用与 90 天内医疗并发症风险降低相关（OR=0.47，p=0.005）。单纯基线大麻使用与 90 天内手术并发症和再入院率或 2 年翻修率无关。
结论
在不伴有任何其他诊断性物质滥用障碍的情况下，基线时单纯吸食大麻与 TLF 治疗 ASD 患者的 90 天内手术并发症或再入院率或 2 年翻修率无相关性，但与不使用者相比，大麻使用者发生 90 天内医疗并发症的可能性更小。有必要进一步研究以明确这些发现的生理机制。
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