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Identifying Key Risk Factors in Elective 1 or 2 Level Lumbar Spine Fusion Patients: A Focus on Patients Classified
Andrea T Kwaczala1, Matthew J Solomito1, Caitlin McCracken1
1Hartford HealthCare Bone and Joint Institute, Hartford, CT, USA.
Spine
|March 11, 2026
Summary
Cannabis use in patients undergoing elective lumbar fusion is linked to higher complication rates and longer recovery. Preoperative screening for cannabis, alcohol, tobacco, and mental health is crucial for optimizing patient outcomes.
Area of Science:
- Spine surgery
- Orthopedics
- Surgical outcomes
Background:
- Preoperative risk factor screening is standard for elective surgeries.
- Cannabis use's impact on postoperative recovery after lumbar fusion is increasingly questioned.
- Understanding these risks is vital for patient management.
Purpose of the Study:
- Identify risk factors associated with 90-day complications.
- Determine factors influencing 12-month recovery metrics after lumbar fusion.
- Evaluate the impact of cannabis use on surgical outcomes.
Main Methods:
- Retrospective case-control study of 575 patients (ages 35-80) undergoing elective lumbar fusion.
- Patients categorized into four groups: high-risk cannabis users (HR-C), high-risk non-users (HR), normal-risk cannabis users (NR-C), and normal-risk non-users (NR).
- Statistical analyses (Chi-squared, ANOVA, regression) compared outcomes and identified predictors of poor results.
Main Results:
- High-risk cannabis users (HR-C) exhibited double the opioid use, longer hospital stays, and more surgical site infections (SSIs) than normal-risk non-users (NR).
- Cannabis use correlated with increased SSI rates.
- Tobacco use, mental illness, alcohol use, and preoperative pain were linked to readmissions, ED visits, and return to OR.
Conclusions:
- Cannabis use is a significant risk factor for adverse outcomes in spinal fusion.
- Preoperative screening should include cannabis, alcohol, tobacco, and mental health assessments.
- Targeted preoperative optimization and postoperative follow-up can improve patient outcomes.
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