Cannabis Use Disorder Increased Rehospitalization and Reoperation After Neck Surgery | Research

The takeaway

Spine surgery patients with cannabis use disorder had 2.6x higher hospital readmission at 90 days and 3.4x higher revision surgery at 1 year after anterior cervical fusion, but paradoxically had fewer overall medical complications.

Spine surgeons, perioperative care teams, and patients with CUD facing surgery

3.4x higher revision surgery at 1 year in CUD patients

What the researchers found

After propensity matching 838 CUD patients to 838 controls, CUD was associated with increased 90-day readmission (OR=2.64, p=0.027) and 1-year revision surgery (OR=3.36, p=0.049). Paradoxically, CUD was associated with reduced overall medical complications at 6 months (OR=0.55, p=0.021) and 1 year (OR=0.54, p=0.015), including fewer cardiac arrhythmias and acute renal failure.

Why it matters

The mixed results challenge simple narratives about cannabis and surgery. While CUD increases the need for repeat surgery and readmission, the reduced medical complications suggest potential protective effects or simply that these younger patients are otherwise healthier.

The numbers in context

838 matched pairs. 90-day readmission: OR=2.64 (p=0.027). 1-year revision: OR=3.36 (p=0.049). 6-month overall complications: OR=0.55 (p=0.021). 1-year complications: OR=0.54 (p=0.015). Reduced cardiac arrhythmias and acute renal failure in CUD group.

How the study worked

Retrospective database analysis of the PearlDiver Database (Jan 2010-Dec 2021) for patients undergoing primary 1-2 level ACDF surgery. Patients with CUD diagnosis 6 months pre-surgery were propensity matched 1:1 to controls on age, gender, and Charlson Comorbidity Index.

What this study cannot tell us

Database study using ICD codes for CUD, which underestimates cannabis use. Propensity matching may not capture all confounders. Cannot determine whether cannabis was actively used perioperatively. The paradoxical complication finding may reflect confounding by age and overall health.

How to read the evidence

Large database with propensity matching, though retrospective design and ICD-code-based CUD identification are limitations.

When this study was published

2024 study using 2010-2021 data

The bigger picture

The finding that CUD patients need more reoperations but have fewer medical complications suggests cannabis may affect surgical healing or pain management (driving revision) while not worsening systemic health. This nuanced finding is more useful than a blanket "good" or "bad" conclusion.

Questions still open

Why do CUD patients need more revision surgery? Is it related to pain management, activity level, or biological effects on bone healing? Does the reduced complication rate reflect younger age and fewer comorbidities not captured by the Charlson Index?

Common questions

Does cannabis use disorder affect spine surgery outcomes?

It depends on the outcome. CUD patients had higher rates of readmission and revision surgery, but paradoxically had fewer medical complications overall after cervical fusion.

Why might CUD patients need more revision spine surgery?

The study cannot definitively answer this, but possibilities include effects on bone healing, pain management challenges leading to activity-related complications, or other unmeasured factors.

Read the original research

Cannabis use Disorder and Complications After Anterior Cervical Diskectomy and Fusion.

World neurosurgery, 181, e1001-e1011

View on PubMed ↗Publisher’s paper ↗

Citation

Van Halm-Lutterodt, Nicholas; Albright, J Alex; Storlie, Nicholas Robert; Mesregah, Mohamed Kamal; Ansari, Kashif; Balmaceno-Criss, Mariah; Daher, Mohammad; Bartels-Mensah, Mercy; Xu, Yulun; Diebo, Bassel G; Hai, Yong; Chandler, David Ray; Daniels, Alan H. (2024). Cannabis use Disorder and Complications After Anterior Cervical Diskectomy and Fusion.. World neurosurgery, 181, e1001-e1011. https://doi.org/10.1016/j.wneu.2023.11.028