High-Dose Opioid Prescription at Hospital Discharge After Spine Trauma: A Propensity-Matched Analysis

Background/Objectives: Opioid requirements among patients with spine trauma vary widely, yet the patient- and injury-level factors associated with high morphine milligram equivalent (MME) dosing at discharge remain unclear. This study aimed to characterize factors associated with high-dose MME at discharge. Methods: We conducted a retrospective cohort study of adult patients with spine trauma from 2019 to 2020. After excluding patients without spine trauma, 1593 patients with an opioid prescription at discharge were categorized into low-dose (below the cohort median MME) and high-dose (at or above the cohort median MME) groups. Patients in the high-dose group were propensity-score matched 1:3 to low-dose controls (with replacement) on age, sex, race, ethnicity, chronic opioid use, chronic pain syndrome, and other substance use. Within the matched cohort, a multivariable logistic regression model with cluster-robust standard errors was fitted to examine factors associated with high-dose MME (cutoff at 384). Covariates included spine trauma group (isolated vs. polytrauma, isolated as reference), injury severity score (ISS) stratum (ISS ≤ 15 as reference), head injury severity category, spine injury severity category, procedural status (non-surgical as reference), mechanical ventilation status (non-ventilated as reference), hospital length of stay, and discharge disposition (home/home health as reference, versus rehabilitation, nursing home, or other facility). Adjusted odds ratios (aORs) with 95% confidence intervals (CIs) were reported. Results: Of the 1593 patients included, 793 were in the low-dose MME group and 800 in the high-dose group. In the propensity-matched cohort, surgical procedures were associated with high-dose MME (aOR 1.52 [95% CI, 1.18–1.95]; p = 0.001). Discharge to inpatient rehabilitation (aOR 0.30 [95% CI, 0.14–0.64]; p = 0.002) and discharge to a nursing home (aOR 0.41 [95% CI, 0.30–0.56]; p < 0.001) were independently associated with lower odds of high-dose MME relative to home discharge. Spine trauma type, ISS stratum, head and spine injury severity category, mechanical ventilation, discharge to other facilities, and hospital length of stay were not associated with high-dose MME. Conclusions: This study demonstrates that discharge opioid prescribing in spine trauma is shaped more by procedural and discharge practices. These findings underscore the need for targeted opioid stewardship interventions at the points of surgical decision-making and discharge planning.