Impact of Preoperative Cannabis Use on Clinical Outcomes of Spinal Fusion-Systematic Review and Meta-analysis.
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#28 Impact of Preoperative Cannabis Use on Clinical Outcomes of Spinal Fusion-Systematic Review and Meta-analysis.
Citation: Łajczak Paweł et al.. Impact of Preoperative Cannabis Use on Clinical Outcomes of Spinal Fusion-Systematic Review and Meta-analysis.. Spine. 2026. PMID: 41563718.
Design: 6 Journal: 0 N: 0 Recency: 3 Pop: 2 Human: 1 Risk: -2
- Preclinical only
Methodological Considerations:
- Retrospective design — selection and information bias risk
Abstract: STUDY DESIGN: Systematic review and meta-analysis. OBJECTIVE: To explore the impact of preoperative cannabis use on perioperative outcomes of spinal fusion procedures. SUMMARY OF BACKGROUND DATA: 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. METHODS: 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. RESULTS: 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. CONCLUSION: 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.
What This Study Teaches Us
Patients who use cannabis before spinal fusion surgery consume significantly more opioids in the hospital afterward, and face higher rates of readmission and repeat surgery. No increase in standard surgical complications was detected, but the functional outcomes were measurably worse.
Why This Matters Clinically
If you counsel patients before spinal fusion or manage their postoperative course, you need to know that active cannabis use associates with higher opioid needs and return visits. This informs preoperative screening and patient counseling, and may shape your risk stratification for follow-up.
Study Snapshot
| Study Design | Systematic review and meta-analysis of 7 retrospective studies |
| Population | 1920 spinal fusion patients total (386 with preoperative cannabis use). Demographics and specific diagnoses not detailed in abstract. |
| Intervention | Preoperative active cannabis use (timing, frequency, dose, and cannabinoid profile not specified) |
| Primary Outcome | Perioperative opioid consumption (morphine milligram equivalents), hospital readmission rate, reoperation rate |
| Key Result | Cannabis users: 58.84 MME more in-hospital opioids (P <0.01); OR 1.70 for readmission (P = 0.045); OR 3.78 for reoperation (P <0.001) |
Where This Paper Deserves Skepticism
All 7 included studies were retrospective, which invites selection bias and unmeasured confounding (e.g., patients with heavier cannabis use may have had more severe baseline pain, anxiety, or substance use histories that independently drive opioid need and poor recovery). The abstract does not specify cannabis dose, frequency, cannabinoid composition, or how recently patients used before surgery, making it unclear whether findings apply to casual users, daily users, or those who stopped weeks prior. No mention of funding source. Generalizability to non-surgical pain management or other procedures remains unknown.
Dr. Caplan’s Take
I read this as a signal worth taking seriously at the preoperative interview, but not as proof of cannabis toxicity in surgery. Retrospective data can’t untangle whether cannabis use itself is the culprit or whether it’s a marker for patients with more complex pain phenotypes, anxiety, or prior opioid exposure. That said, the reoperation signal is notable and probably real. My approach: screen actively for cannabis use before fusion, discuss these outcomes candidly, and encourage patients to taper if they’re willing. But I don’t treat it as an absolute contraindication, and I recognize that for some patients, stopping cannabis might paradoxically worsen perioperative anxiety and pain.
Clinical Bottom Line
Preoperative cannabis use is associated with higher postoperative opioid demand and worse intermediate outcomes after spinal fusion. Include it in your preoperative risk discussion and consider encouraging cessation or reduction beforehand, while recognizing that causation is not proven.
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