The Effect of Preoperative Marijuana Use on Surgical Outcomes, Patient-Reported Outcomes, and Opioid Consumption Following Lumbar Fusion

Abstract

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, P = .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, P > .05). The quantity of pre- and postoperative opioids prescriptions was not significantly different between groups (all, P > .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

The Impact of Marijuana Use in Patients Undergoing Spine Surgery

“…A review of 240 patients by Lambrechts et al25 studied outcomes of patients who underwent primary 1- to 4-level anterior cervical discectomy and fusion surgeries, 60 of whom used marijuana preoperatively. Another retrospective review by D'Antonio et al26 looked at 259 patients who underwent lumbar spine fusion, 65 of whom used marijuana preoperatively. Both of these studies showed that marijuana did not affect postoperative opioid consumption 25,26.…”

“…Another retrospective review by D'Antonio et al26 looked at 259 patients who underwent lumbar spine fusion, 65 of whom used marijuana preoperatively. Both of these studies showed that marijuana did not affect postoperative opioid consumption 25,26. One major limitation of these retrospective studies is that participants were classified as marijuana users or nonusers but were not further stratified by pre- or postoperative use, frequency and quantity of use, duration of use, or route of administration.…”

“…Both of these studies showed that marijuana did not affect postoperative opioid consumption. 25,26 One major limitation of these retrospective studies is that participants were classified as marijuana users or nonusers but were not further stratified by pre-or postoperative use, frequency and quantity of use, duration of use, or route of administration. Furthermore, these studies did not distinguish between the recreational and medical use of marijuana.…”

The Impact of Marijuana Use in Patients Undergoing Spine Surgery

“…A review of 240 patients by Lambrechts et al 25 studied outcomes of patients who underwent primary 1-to 4-level anterior cervical discectomy and fusion surgeries, 60 of whom used marijuana preoperatively. Another retrospective review by D'Antonio et al 26 looked at 259 patients who underwent lumbar spine fusion, 65 of whom used marijuana preoperatively. Both of these studies showed that marijuana did not affect postoperative opioid consumption.…”

“…In addition, the review by D'Antonio et al found that marijuana users were more likely to have a spine reoperation within 3 years (P = 0.041) but did not find any significant differences in surgical outcomes or patient-reported outcomes between the 2 groups. 26 All these studies have similar limitations in that they do not define the quantity, timing, or route of administration of marijuana use.…”