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For patients undergoing spine surgery, the diagnosis of cannabis use disorder is associated with higher complication rates, including significantly increased risks of stroke and respiratory complications, one suggested. new study.
The results of the study were published in Spine. The journal is published in the Lippincott portfolio by Wolters Kluwer.
“Chronic cannabis use in patients undergoing spine surgery is associated with higher rates of neurovascular, thromboembolic and pulmonary complications in the hospital setting, and a less favorable general discharge disposition,” according to new research from ‘Ankit Indravadan Mehta, MD, FAANS and colleagues at the University of Illinois at Chicago.
Mehta added, “The treatment of these patients is also associated with an increase in length of stay and hospital costs.”
Using a Nationwide Inpatient Sample database, researchers identified nearly 433,000 patients who underwent common elective spine surgeries between 2012 and 2015. About 2,400 patients had a diagnosis of cannabis use disorder, defined as continued cannabis use despite significant distress or impairment.
During the initial analysis, there were significant differences between patients with and without cannabis use disorder. Patients diagnosed with problematic cannabis use were younger, more likely to be men, and had lower rates of medical conditions (comorbidity). They were also much more likely to use tobacco: around 71% versus 31%.
Using a technique called propensity score matching, Dr. Mehta and his colleagues created matched groups of 2,184 chronic cannabis users versus non-users with similar characteristics and co-morbidities. A wide range of complications and other inpatient spine surgery outcomes were compared between groups.
Patients with cannabis use disorders were at increased risk for several types of complications after spinal surgery. Cannabis users were about twice as likely to develop respiratory and blood clot-related complications (thromboembolism). They also had almost three times the risk of stroke and other neurological complications. The risk of blood infection (sepsis or sepsis) increased by 50%.
There were also more myocardial infarctions (heart attacks) in patients with cannabis use disorders. However, upon further analysis, it was linked to their much higher smoking rate.
Patients with cannabis use disorders also spent almost two more days in hospital (about seven versus five days) and had hospital costs nearly $ 15,000 higher. They were also more likely to be referred to a nursing or rehabilitation facility and less likely to receive health care at home.
The results are of particular concern as cannabis use is increasingly legalized and accepted in the United States. Estimates suggest that over 15% of Americans use cannabis. Rates of cannabis use and cannabis use disorders have “increased dramatically” in recent years, according to the authors.
The results have important implications for anesthesia and surgical management in patients with cannabis use disorders, believe Dr Mehta and colleagues. For example, these patients may need higher doses of opioid drugs to achieve adequate pain management after spine surgery.
This can lead to slower recovery, requiring longer hospital stays and more intensive rehabilitation that cannot be done at home. The researchers also note previous studies describing the mechanisms by which cannabis use may lead to an increased risk of respiratory, thromboembolic and neurological complications.
“This study reveals multiple aspects of perioperative care that are extremely complex and difficult in patients with cannabis use disorders,” wrote Dr. Mehta and co-authors.
They added: “Their high risk cardiorespiratory profiles combined with specialized anesthetic considerations [before, during, and after surgery] require very unique perioperative management. We hope that this research will lead to future prospective trials for specific interventions that could improve outcomes in this specific population. “
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