Identifying Key Risk Factors in Elective 1 or 2 Level Lumbar Spine Fusion Patients

STUDY DESIGN: Retrospective case-control study. OBJECTIVES: The goal of this study was to identify key risk factors that were associated with 90-day complication rates, and 12-month recovery metrics following an elective single or 2-level lumbar fusion. SUMMARY OF BACKGROUND DATA: Preoperative screening for risk factors associated with poor outcomes is common in elective surgeries. Recent changes in legal status of cannabis has led to questions concerning the impact of cannabis use on postoperative recovery, complications, and pain management in patients undergoing elective lumbar fusions. METHODS: This retrospective study included patients ages 35 to 80 who underwent elective single- or two-level lumbar fusions between January 2022 and May 2025. Patients were classified as either high-risk or normal risk during their preoperative optimization visit. Four groups were created based on risk classification and cannabis use: high-risk cannabis users (HR-C), high-risk non-users (HR), normal risk cannabis users (NR-C), and normal risk non-users (NR). Differences were compared using Chi-squared tests and ANOVAs. Regression analyses identified preoperative metrics associated with poor outcomes. RESULTS: A total of 575 patients (142 HR, 30 HR-C, 433 NR, 101 NR-C) were included. HR-C patients showed two-fold higher opioid use ( P