术前使用大麻对腰椎融合术后手术结果、患者报告结局及阿片类药物消耗量的影响。
The Effect of Preoperative Marijuana Use on Surgical Outcomes, Patient-Reported Outcomes, and Opioid Consumption Following Lumbar Fusion.
作者信息
D'Antonio Nicholas D, Lambrechts Mark J, Heard Jeremy C, Siegel Nicholas, Karamian Brian A, Huang Angela, Canseco Jose A, Woods Barrett, Kaye Ian David, Hilibrand Alan S, Kepler Christopher K, Vaccaro Alexander R, Schroeder Gregory D
机构信息
Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA.
出版信息
Global Spine J. 2024 Mar;14(2):568-576. doi: 10.1177/21925682221116819. Epub 2022 Jul 18.
STUDY DESIGN
Retrospective Cohort Study.
OBJECTIVES
To (1) investigate the effect of marijuana use on surgical outcomes following lumbar fusion, (2) determine how marijuana use affects patient-reported outcomes measures (PROMs), and (3) determine if marijuana use impacts the quantity of opioids prescribed.
METHODS
Patients 18 years of age who underwent primary one- or two-level lumbar fusion with preoperative marijuana use at our institution were identified. A 3:1 propensity match incorporating patient demographics and procedure type was conducted to compare preoperative marijuana users to non-marijuana users. Patient demographics, surgical characteristics, surgical outcomes (90-day all-cause and 90-day surgical readmissions, reoperations, and revision surgeries), pre- and postoperative narcotic usage, and PROMs were compared between groups. Multivariate regression models were created to determine the effect of marijuana on surgical reoperations patient-reported outcomes (PROMs) 1-year postoperatively.
RESULTS
Of the 259 included patients, 65 used marijuana preoperatively. Multivariate logistic regression analysis demonstrated that marijuana use (OR = 2.28, = .041) significantly increased the likelihood of having a spine reoperation. No other surgical outcome was found to be significantly different between groups. Multivariate linear regression analysis showed that marijuana use was not significantly associated with changes in 1-year postoperative PROMs (all, > .05). The quantity of pre- and postoperative opioids prescriptions was not significantly different between groups (all, > .05).
CONCLUSIONS
Preoperative marijuana use increased the likelihood of a spine reoperation for any indication following lumbar fusion, but it was not associated with 90-day all cause readmission, surgical readmission, the magnitude of improvement in PROMs, or differences in opioid consumption.
LEVEL OF EVIDENCE
III.
研究设计
回顾性队列研究。
目的
（1）调查大麻使用对腰椎融合术后手术结果的影响；（2）确定大麻使用如何影响患者报告的结局指标（PROMs）；（3）确定大麻使用是否会影响阿片类药物的处方量。
方法
识别出在我们机构接受初次单节段或双节段腰椎融合且术前使用大麻的18岁患者。采用倾向得分匹配法（3:1），纳入患者人口统计学和手术类型，将术前大麻使用者与非大麻使用者进行比较。比较两组患者的人口统计学、手术特征、手术结果（90天全因再入院率、90天手术再入院率、再次手术和翻修手术）、术前和术后麻醉药物使用情况以及PROMs。建立多变量回归模型，以确定大麻对术后1年手术再次手术患者报告结局（PROMs）的影响。
结果
在纳入的259例患者中，65例术前使用大麻。多变量逻辑回归分析表明，大麻使用（OR = 2.28，P = .041）显著增加了脊柱再次手术的可能性。未发现其他手术结果在两组之间有显著差异。多变量线性回归分析表明，大麻使用与术后1年PROMs的变化无显著相关性（所有P值均＞.05）。两组术前和术后阿片类药物处方量无显著差异（所有P值均＞.05）。
结论
术前使用大麻增加了腰椎融合术后因任何指征进行脊柱再次手术的可能性，但与90天全因再入院、手术再入院、PROMs改善程度或阿片类药物消耗量差异无关。
证据级别
III级。
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