P82. The association of cannabis use disorder in patients undergoing primary 1- to 2- level lumbar fusion: an analysis of a nationwide claims database

Abstract

<h3>BACKGROUND CONTEXT</h3> As the legalization of cannabis continues to increase nationwide, studies evaluating the association of cannabis use disorder (CUD) on outcomes following primary 1- to 2- level lumbar fusion (1-2LF) for lumbar degenerative disc disease (DDD) is of critical importance. <h3>PURPOSE</h3> Therefore, the aims of this study were to utilize a large nationwide administrative claims database to determine whether CUD patients undergoing 1-2LF for lumbar is associated with: 1) longer in-hospital lengths of stay (LOS); 2) medical complications; and 3) costs of care. <h3>STUDY DESIGN/SETTING</h3> Using a nationwide United States private payor database, a retrospective query from January 1, 2010 to December 31, 2018 was performed. Patients and complications were identified using International Classification of Disease, Ninth Revision (ICD-9), ICD-10, and Current Procedural Terminology (CPT) codes. <h3>PATIENT SAMPLE</h3> The inclusion criteria for the study group consisted of those patients undergoing primary 1-2LF for lumbar DDD who have CUD, while those patients without CUD served as the comparison cohort. Exclusions from the study were those patients undergoing spine surgery for traumatic causes, malignancy, infections, or more than 1- to 2- levels. To minimize any potential confounding bias, study group patients were 1:5 ratio matched to a comparison cohort by age, sex, and the following comorbid conditions - alcohol abuse, chronic obstructive pulmonary disease (COPD), diabetes mellitus, hyperlipidemia, hypertension, and obesity - defined as a body mass index greater than 30 kilograms per meter squared (kg/m2). Ratio matching was used to increase the overall sample size of the study. The aforementioned comorbid conditions were used as they have been associated with CUD. Following the random matching sequence, the query yielded 22,815 patients within the study (n = 3,805) and comparison (n = 19,010) cohort. <h3>OUTCOME MEASURES</h3> Primary endpoints of the study were to compare in-hospital LOS, 90-day medical complications, in addition to day of surgery and total global 90-day episode of care costs. <h3>METHODS</h3> Welch's t-tests were used to compare in-hospital LOS and costs of care, whereas a multivariate logistic regression model was used to calculate the odds-ratios (OR) and 95% confidence intervals (95%CI) on CUD on 90-day medical complications. Due to the ease of finding statistical significance with large database studies, a Bonferroni correction was performed to reduce the probability of a type I error. Thus, a p-value less than 0.001 was considered to be statistically significant. <h3>RESULTS</h3> CUD patients were found to have significantly longer in-hospital LOS compared to their counterparts (5- vs. 3- days, p < 0.0001). Additionally, CUD patients incurred significantly higher rates and odds of developing medical complications (31.88 vs. 18.01%; OR: 1.41, 95%CI: 1.29 to 1.54, p < 0.0001) such as deep vein thromboses (0.63 vs. 0.14%; OR: 3.07, 95%CI: 1.73 to 5.41, p < 0.0001), respiratory failures (0.81 vs. 0.22%: OR: 2.57, 95%CI: 1.58 to 4.13, p < 0.0001), myocardial infarctions (0.87 vs. 0.29%; OR: 2.08, 95%CI: 1.32 to 3.23, p < 0.0001), acute kidney injuries (4.05 vs. 1.62%; OR: 1.74, 95%CI: 1.41 to 2.14, p < 0.0001), pneumoniae (4.73 vs. 2.35%; OR: 1.51, 95%CI: 1.26 to 1.82, p < 0.0001), in addition to other complications (Table 2). CUD patients were also found to have significantly higher day of surgery ($54,196.00 vs. $52,717.26, p < 0.0001) and total global 90-day episode of care costs ($58,252.53 vs. $57,041.93, p < 0.0001). <h3>CONCLUSIONS</h3> As the number of states continue to decriminalize and legalize cannabis use, understanding the impact of CUD following surgical procedures is of critical importance. This study aimed to analyze the association of CUD on outcomes following 1-2LF for lumbar DDD. After adjusting for baseline covariates, this study of over 22,000 patients demonstrated CUD to be associated with longer in-hospital LOS, and higher rates of 90-day complications and healthcare expenditures. The study is vital as it can allow orthopedic surgeons and health care professionals to adequately educate patients on the outcomes of their procedure. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.