Cannabis Users Face Higher Opioid Use and Reoperation Rates After Spinal Fusion

Meta-analysis of 7 studies (1,920 patients, 386 cannabis users) found significant increases in in-hospital opioid use (+58.84 MME), readmission (OR 1.70), and reoperation (OR 3.78) among cannabis users undergoing spinal fusion. No significant increase in surgical complications was observed.

Systematic review and meta-analysis searching PubMed, Scopus, Web of Science, and Cochrane Library for studies comparing spinal fusion outcomes between preoperative cannabis users and non-users. Seven retrospective studies with 1,920 patients were included.

Spinal fusion is one of the most common major surgeries, and cannabis use is increasingly prevalent among patients with chronic back pain. These findings suggest spine surgeons should screen for and counsel patients about cannabis use before surgery.

The nearly 4-fold increase in reoperation risk is particularly alarming and suggests cannabis may affect not just acute pain management but also longer-term healing. This could change how spine surgeons approach preoperative cannabis cessation counseling.

All 7 included studies were retrospective. Cannabis use was often self-reported and not standardized. Cannot account for confounding factors like chronic pain severity that might independently predict worse outcomes. Relatively small cannabis user group (386).