Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA.
Cooper Medical School of Rowan University, Camden, NJ.
Spine (Phila Pa 1976). 2022 Nov 15;47(22):1558-1566. doi: 10.1097/BRS.0000000000004431. Epub 2022 Jul 15.
A retrospective cohort study.
To determine if (1) preoperative marijuana use increased complications, readmission, or reoperation rates following anterior cervical discectomy and fusion (ACDF), (2) identify if preoperative marijuana use resulted in worse patient-reported outcome measures (PROMs), and (3) investigate if preoperative marijuana use affects the quantity of opioid prescriptions in the perioperative period.
A growing number of states have legalized recreational and/or medical marijuana, thus increasing the number of patients who report preoperative marijuana use. The effects of marijuana on clinical outcomes and PROMs in the postoperative period are unknown.
All patients 18 years of age and older who underwent primary one- to four-level ACDF with preoperative marijuana use at our academic institution were retrospectively identified. A 3:1 propensity match was conducted to compare patients who used marijuana versus those who did not. Patient demographics, surgical characteristics, clinical outcomes, and PROMs were compared between groups. Multivariate regression models measured the effect of marijuana use on the likelihood of requiring a reoperation and whether marijuana use predicted inferior PROM improvements at the one-year postoperative period.
Of the 240 patients included, 60 (25.0%) used marijuana preoperatively. Multivariate logistic regression analysis identified marijuana use (odds ratio=5.62, P <0.001) as a predictor of a cervical spine reoperation after ACDF. Patients who used marijuana preoperatively had worse one-year postoperative Physical Component Scores of the Short-Form 12 (PCS-12) ( P =0.001), Neck Disability Index ( P =0.003), Visual Analogue Scale (VAS) Arm ( P =0.044) and VAS Neck ( P =0.012). Multivariate linear regression found preoperative marijuana use did not independently predict improvement in PCS-12 (β=-4.62, P =0.096), Neck Disability Index (β=9.51, P =0.062), Mental Component Scores of the Short-Form 12 (MCS-12) (β=-1.16, P =0.694), VAS Arm (β=0.06, P =0.944), or VAS Neck (β=-0.44, P =0.617).
Preoperative marijuana use increased the risk of a cervical spine reoperation after ACDF, but it did not significantly change the amount of postoperative opioids used or the magnitude of improvement in PROMs.
Levwl III.
回顾性队列研究。
确定（1）术前大麻使用是否会增加前路颈椎间盘切除融合术（ACDF）后的并发症、再入院或再次手术率，（2）确定术前大麻使用是否会导致患者报告的结果测量（PROMs）更差，以及（3）调查术前大麻使用是否会影响围手术期阿片类药物处方的数量。
越来越多的州已经将娱乐和/或医用大麻合法化，因此报告术前大麻使用的患者数量增加。大麻对术后临床结果和 PROMs 的影响尚不清楚。
我们回顾性地确定了在我们的学术机构接受初次一至四级 ACDF 并在术前使用大麻的所有 18 岁及以上的患者。进行了 3:1 的倾向匹配，以比较使用大麻的患者与未使用大麻的患者。比较两组患者的人口统计学特征、手术特点、临床结果和 PROMs。多变量回归模型测量了大麻使用对再次手术可能性的影响，以及大麻使用是否预测术后一年 PROM 改善程度较差。
在 240 名患者中，有 60 名（25.0%）术前使用了大麻。多变量逻辑回归分析确定大麻使用（比值比=5.62，P <0.001）是 ACDF 后颈椎再手术的预测因素。术前使用大麻的患者在术后一年的简明健康调查量表 12 项短式量表（PCS-12）的物理成分评分（ P =0.001）、颈部残疾指数（ P =0.003）、视觉模拟量表（VAS）手臂（ P =0.044）和 VAS 颈部（ P =0.012）方面表现更差。多变量线性回归发现术前大麻使用不能独立预测 PCS-12（β=-4.62，P =0.096）、颈部残疾指数（β=9.51，P =0.062）、简明健康调查量表 12 项短式量表（MCS-12）的精神成分评分（β=-1.16，P =0.694）、VAS 手臂（β=0.06，P =0.944）或 VAS 颈部（β=-0.44，P =0.617）的改善。
术前大麻使用增加了 ACDF 后颈椎再手术的风险，但并未显著改变术后阿片类药物的使用量或 PROMs 改善的程度。
Levwl III。
