The Association Between Preoperative Cannabis Use and Anxiety, Pain Scores and Opioid Consumption in Patients Undergoing Spinal Fusion: A Retrospective Cohort Study

Study DesignRetrospective cohort study.ObjectiveDespite increasing cannabis use, its prevalence in specific surgical groups is unclear, and its impact on perioperative care and outcomes is understudied. This study estimates cannabis use incidence in patients undergoing lumbar spine surgery and explores associations between preoperative use and anxiety, pain scores, and postoperative opioid consumption. We hypothesized a correlation between cannabis use and decreased reliance on opioids for postoperative pain relief.MethodsThis single-center retrospective cohort study included 204 patients undergoing single or multilevel spinal fusion surgery between July 2022 and August 2023. Self-reported cannabis use, demographics, surgical characteristics, numeric rating scale (NRS) pain scores, anxiety, inpatient opioid consumption, and discharge prescribing (total morphine equivalent dose) were extracted from electronic medical records (EMR). Patients were categorized into cannabis users or non-cannabis users, and group differences were analyzed using bivariable and multivariable regression.ResultsOf 204 patients, 27 (13.2%) were cannabis users and 177 (86.8%) were non-users. Cannabis users were younger (<i>P</i> = 0.007), more likely male (<i>P</i> = 0.028), and Caucasian (<i>P</i> = 0.032) than non-users. Preoperative cannabis use correlated significantly with anxiety disorder (<i>P</i> = 0.023) and higher preoperative (<i>P</i> = 0.016) and postoperative (<i>P</i> = 0.002) NRS pain scores. Multivariable analysis showed cannabis use associated with higher preoperative (<i>P</i> = 0.015) but not postoperative (<i>P</i> = 0.073) pain scores. No significant differences were found in preoperative, discharge opioid prescribing or postoperative opioid consumption.ConclusionThe incidence of cannabis use was low, but positively associated with anxiety and higher preoperative NRS pain scores. Large, well-powered trials are needed to understand cannabis's impact on spine surgery outcomes.