Preoperative Opioid Burden Shows Nominal Link to Spine Tumor Discharge Needs

In a retrospective study evaluating preoperative opioid exposure in spine oncology patients, higher preoperative opioid burden demonstrated nominal associations with non-home discharge disposition following surgery, although these associations did not remain statistically significant after correction for multiple comparisons. While preoperative opioid use is highly prevalent among spine surgery patients and has been associated with adverse postoperative outcomes in degenerative spine and adult spinal deformity cohorts, its perioperative significance among patients undergoing surgery for spinal tumors has remained poorly characterized.

To investigate this relationship, researchers retrospectively reviewed 290 spinal tumor patients with documented preoperative opioid exposure. The investigators quantified preoperative opioid burden using two distinct metrics: morphine equivalent daily dose (MEDD) and cumulative morphine equivalent dose (MED), analyzing both metrics as continuous variables and as dichotomized variables. Using multivariable regression models, the study evaluated associations between these exposure measures and postoperative outcomes, including discharge disposition, hospital length of stay, and emergency department visits and hospital readmissions at 30 and 90 days, with coarsened exact matching performed as a sensitivity analysis.

Following multivariable adjustment, continuous MEDD was nominally associated with increased odds of non-home discharge (odds ratio 1.0029, 95% confidence interval 1.0006–1.0055, p = 0.019), as was continuous MED (odds ratio 1.0934 per 1,000 mg, 95% confidence interval 1.0117–1.1896, p = 0.030) and MEDD above the cohort median (odds ratio 1.6891, 95% confidence interval 1.0145–2.8317, p = 0.045). However, none of these observed associations retained statistical significance following false discovery rate correction. Furthermore, the analysis identified no statistically significant associations between preoperative opioid burden and hospital length of stay, 30-day or 90-day emergency department visits, or 30-day or 90-day hospital readmissions.

In the sensitivity analysis using coarsened exact matching, 42 MEDD pairs and 40 MED pairs were retained, but the resulting matched analyses yielded imprecise estimates accompanied by wide confidence intervals, limiting further interpretation. The study authors concluded that these exploratory findings indicate discharge disposition may warrant further investigation as an outcome associated with preoperative opioid burden in spine tumor surgery, while emphasizing that the initial nominal associations did not withstand adjustment for multiple testing.

Subject of Research: Preoperative opioid burden and postoperative discharge disposition in spine tumor surgery

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

Article References: Park, K. H., Golubovsky, J. L., Cirvello, J., Messing, I., McClintock, S. D., Butala, A., Peters, G. W., Hassankhani, A., Knollman, H. M., Schuster, J., Freeman, C. W., & Malhotra, N. R. (2026). Association between preoperative opioid burden and disposition needs after spine tumor surgery. Acta Neurochirurgica. https://doi.org/10.1007/s00701-026-07080-2

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DOI: 10.1007/s00701-026-07080-2

Keywords: spine tumor surgery, preoperative opioid burden, discharge disposition, morphine equivalent daily dose, spine oncology, postoperative outcomes, retrospective study, Association, between, preoperative, opioid, burden