Impact of Preoperative Cannabis Use on Clinical Outcomes of Spinal Fusion-Systematic Review and Meta-analysis

Systematic review and meta-analysis. To explore the impact of preoperative cannabis use on perioperative outcomes of spinal fusion procedures. Opioid use disorder is a growing problem, especially in the United States. Cannabis use is increasingly being adopted as an alternative method of pain management. However, it remains unclear how a history of preoperative cannabis use impacts opioid consumption, length of hospitalization, or perioperative complications in spinal fusion procedures. The authors searched PubMed, Scopus, Web of Science, and Cochrane Library for studies where outcomes of spinal fusion were compared between patients preoperatively exposed and nonexposed to active cannabis use. A total of 7 retrospective studies and 1920 patients (386 cannabis users) were included. Significant increase in in-hospital opioid use (MD 58.84 MME; 95% CI: 29.75-87.93; P <0.01), readmission (OR 1.70; 95% CI: 1.01-2.87; P =0.045), and reoperation (OR 3.78; 95% CI: 2.06-6.94; P <0.001) was observed in the cannabis group. Studies showed no significant increase in surgical complications. A history of preoperative cannabis use may be associated with poorer surgical outcomes, including increased perioperative opioid utilization and a higher rate of postoperative hospital readmissions. Patients should be informed in detail about these risks, and clinicians should screen for them. Counsel patients to cease or at least reduce the use of cannabis before a spinal fusion procedure, in order to minimize surgical complications.