Association between preoperative opioid burden and disposition needs after spine tumor surgery

Abstract Introduction Preoperative opioid use is highly prevalent among spine surgery patients and has been associated with adverse postoperative outcomes in degenerative and adult spinal deformity populations. However, the perioperative significance of opioid burden in spine oncology patients remains poorly characterized. Methods We retrospectively reviewed 290 spinal tumor patients with documented preoperative opioid exposure. Opioid burden was quantified using morphine equivalent daily dose (MEDD) and cumulative morphine equivalent dose (MED), analyzed as both continuous and dichotomized variables. Associations with discharge disposition, hospital length of stay (LOS), and 30- and 90-day emergency department (ED) visits and readmissions were evaluated using multivariable regression, with coarsened exact matching (CEM) performed as a sensitivity analysis. Results Following multivariable adjustment, higher continuous MEDD (OR 1.0029, 95% CI 1.0006–1.0055, p = 0.019), continuous MED (OR 1.0934 per 1,000 mg, 95% CI 1.0117–1.1896, p = 0.030), and MEDD above the cohort median (OR 1.6891, 95% CI 1.0145–2.8317, p = 0.045) were associated with increased odds of non-home discharge. However, these associations did not remain statistically significant following false discovery rate correction. No significant associations were identified with LOS, ED visits, or readmissions within 30 or 90 days. Following CEM, 42 MEDD pairs and 40 MED pairs were retained. Matched analyses yielded imprecise estimates with wide confidence intervals, limiting further interpretation. Conclusions Higher preoperative opioid burden demonstrated nominal associations with non-home discharge following spine tumor surgery, although these findings did not remain significant after correction for multiple comparisons. These exploratory findings suggest that discharge disposition may warrant further investigation as an outcome associated with preoperative opioid burden.