Trenchfield Delano, Lee Yunsoo, Brush Parker, McCurdy Michael, Lambrechts Mark, Narayanan Rajkishen, Christianson Alex, Deez Azra, Wiafe Bright, Kaye Ian David, Canseco Jose, Hilibrand Alan S, Vaccaro Alexander R, Kepler Christopher, Schroeder Gregory
Department of Orthopaedic Surgery, Rothman Orthopaedic Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Department of Orthopaedic Surgery, Washington University Hospital, St. Louis, MO, USA.
Global Spine J. 2025 Mar;15(2):633-638. doi: 10.1177/21925682231203650. Epub 2023 Sep 20.
Retrospective Cohort Study.
Our study aims to analyze the effect of preoperative marijuana use on outcomes and postoperative opioid use in patients who have undergone lumbar decompression without fusion.
All patients >18 years of age who underwent lumbar decompression from 2017-2022 with documented preoperative marijuana use at our academic institution were retrospectively identified. A 3:1 propensity match incorporating demographics, procedure type, and levels decompressed was performed to compare preoperative marijuana users and non-users. 1-year preoperative and postoperative opioid consumption in milligrams of morphine equivalents and postoperative outcomes including readmissions, reoperations, and complications, were obtained. A multivariate regression model was performed to measure the effect of marijuana use on the likelihood of a spine reoperation.
Of the 340 included patients, 85 were preoperative marijuana users. There were no significant differences in medical complications, 90-day readmissions, or opioid consumption preoperatively or postoperatively ( > .05). We identified a trend towards patients who used marijuana having more reoperations for any cause (20.0% vs 11.37%, = .067). Multivariate logistic regression analysis suggested that preoperative marijuana use was a significant predictor of all-spine reoperations (OR = 2.06, = .036).
In lumbar decompression patients, preoperative marijuana use does not impact opioid consumption, readmissions, or medical complications, but is a significant predictor of future postoperative reoperations. Additional research is necessary to further explore the role of marijuana use in spine surgery.
回顾性队列研究。
我们的研究旨在分析术前使用大麻对接受非融合性腰椎减压手术患者的预后及术后阿片类药物使用情况的影响。
回顾性确定了2017年至2022年在我们学术机构接受腰椎减压手术且术前有大麻使用记录的所有18岁以上患者。采用倾向评分匹配法，按照3:1的比例，纳入人口统计学、手术类型和减压节段等因素进行匹配，以比较术前大麻使用者和非使用者。获取术前和术后1年以吗啡当量毫克数表示的阿片类药物消耗量，以及术后包括再入院、再次手术和并发症在内的预后情况。进行多变量回归模型分析，以衡量大麻使用对脊柱再次手术可能性的影响。
在纳入的340例患者中，85例为术前大麻使用者。在医疗并发症、90天再入院率或术前及术后阿片类药物消耗量方面，两组之间均无显著差异（P>0.05）。我们发现，因任何原因接受再次手术的大麻使用者呈现出增多的趋势（20.0%对11.37%，P = 0.067）。多变量逻辑回归分析表明，术前使用大麻是全脊柱再次手术的显著预测因素（比值比 = 2.06，P = 0.036）。
在腰椎减压手术患者中，术前使用大麻不会影响阿片类药物的消耗量、再入院率或医疗并发症，但却是未来术后再次手术的显著预测因素。有必要开展更多研究，以进一步探讨大麻使用在脊柱手术中的作用。
