Cannabis use disorder was linked to more complications after spine fusion surgery but also less opioid dependence

Among 72,024 cervical and 105,612 lumbar fusion patients, those with CUD (2% and 1.5% respectively) had higher complication rates including neurological complications, wound complications, and cardiac events at various time points. CUD was associated with increased stroke risk in cervical fusions and cardiac/MI complications in lumbar fusions. However, CUD was also associated with decreased opioid dependence postoperatively. No differences in reoperation rates were observed.

Retrospective cohort using IBM MarketScan Database (2009-2019). Exact match hospitalization analysis with outcomes at index hospitalization, 6 months, and 12 months. Patients with and without CUD were compared.

With growing cannabis use, spine surgeons need to know how CUD affects surgical outcomes. The dual finding of more complications but less opioid dependence creates a complex risk-benefit picture for perioperative management.

The paradox of more surgical complications but less opioid dependence suggests cannabis users may have different pain management trajectories. Surgeons may need to monitor for specific complications while potentially leveraging the reduced opioid risk.

Administrative database cannot control for confounding by other substance use or socioeconomic factors. CUD patients were younger males with higher comorbidity burden. CUD diagnosis codes undercount cannabis use. Cannot determine dose, frequency, or timing of use.