Department of Neurosurgery, University of Louisville, Louisville, KY.
Cornell University, Ithaca, NY.
Spine (Phila Pa 1976). 2024 Feb 15;49(4):E28-E45. doi: 10.1097/BRS.0000000000004874. Epub 2023 Nov 10.
A retrospective cohort study.
To identify differences in complication rates after cervical and lumbar fusion over the first postoperative year between those with and without cannabis use disorder (CUD) and to assess how CUD affects opioid prescription patterns.
Cannabis is legal for medical purposes in 36 states and for recreational use in 18 states. Cannabis has multisystem effects and may contribute to transient vasoconstrictive, prothrombotic, and inflammatory effects.
The IBM MarketScan Database (2009-2019) was used to identify patients who underwent cervical or lumbar fusions, with or without CUD. Exact match hospitalization and postdischarge outcomes were analyzed at index, six, and 12 months.
Of 72,024 cervical fusion (2.0% with CUD) and 105,612 lumbar fusion patients (1.5% with CUD), individuals with CUD were more likely to be young males with higher Elixhauser index. The cervical CUD group had increased neurological complications (3% vs. 2%) and sepsis (1% vs. 0%) during the index hospitalization and neurological (7% vs. 5%) and wound complications (5% vs. 3%) at 12 months. The lumbar CUD group had increased wound (8% vs. 5%) and myocardial infarction (MI) (2% vs. 1%) complications at six months and at 12 months. For those with cervical myelopathy, increased risk of pulmonary complications was observed with CUD at index hospitalization and 12-month follow-up. For those with lumbar stenosis, cardiac complications and MI were associated with CUD at index hospitalization and 12 months. CUD was associated with opiate use disorder, decreasing postoperatively.
No differences in reoperation rates were observed for CUD groups undergoing cervical or lumbar fusion. CUD was associated with an increased risk of stroke for the cervical fusion cohort and cardiac (including MI) and pulmonary complications for lumbar fusion at index hospitalization and six and 12 months postoperatively. Opiate use disorder and decreased opiate dependence after surgery also correlated with CUD.
回顾性队列研究。
在术后第一年,确定患有和不患有大麻使用障碍(CUD)的颈椎和腰椎融合患者的并发症发生率差异,并评估 CUD 如何影响阿片类药物处方模式。
大麻在 36 个州被用于医疗目的,在 18 个州被用于娱乐目的。大麻具有多系统作用,可能导致短暂的血管收缩、血栓形成和炎症作用。
使用 IBM MarketScan 数据库(2009-2019 年),确定接受颈椎或腰椎融合术的患者,包括患有和不患有 CUD 的患者。在索引、6 个月和 12 个月时,对确切匹配的住院和出院后结果进行分析。
在 72024 例颈椎融合术(2.0%患有 CUD)和 105612 例腰椎融合术患者(1.5%患有 CUD)中,患有 CUD 的患者更可能是年轻男性,Elixhauser 指数更高。颈椎 CUD 组在索引住院期间出现更多神经并发症(3%比 2%)和脓毒症(1%比 0%),在 12 个月时出现更多神经并发症(7%比 5%)和伤口并发症(5%比 3%)。腰椎 CUD 组在 6 个月和 12 个月时出现更多的伤口(8%比 5%)和心肌梗死(MI)(2%比 1%)并发症。对于患有颈椎脊髓病的患者,在索引住院和 12 个月随访时,CUD 增加了肺部并发症的风险。对于患有腰椎狭窄症的患者,CUD 与索引住院和 12 个月时的心脏并发症和 MI 相关。CUD 与术后阿片类药物使用障碍相关,且术后阿片类药物使用障碍减少。
在接受颈椎或腰椎融合术的 CUD 组中,再手术率没有差异。CUD 与颈椎融合患者的中风风险增加以及腰椎融合患者的心脏(包括 MI)和肺部并发症相关,这些并发症发生在索引住院和术后 6 个月和 12 个月时。术后阿片类药物使用障碍和阿片类药物依赖的减少也与 CUD 相关。