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. 2021 Nov 1;157(11):1299-1305.
doi: 10.1001/jamadermatol.2021.3468.

Rates of Opioid Prescriptions Obtained After Mohs Surgery: A Claims Database Analysis From 2009 to 2020

Surya A Veerabagu  1 , Brian Cheng  2 , Sonia Wang  3 , Jeremy R Etzkorn  4 , Austin S Kilaru  5 , Megan H Noe  6 , Christopher J Miller  4 , Joseph F Sobanko  4 , Thuzar M Shin  4 , H William Higgins 2nd  4 , Stacy L McMurray  4 , Aimee E Krausz  4 , Joanna L Walker  4 , Cerrene N Giordano  4
Affiliations

Rates of Opioid Prescriptions Obtained After Mohs Surgery: A Claims Database Analysis From 2009 to 2020

Surya A Veerabagu et al. JAMA Dermatol. .

Abstract

Importance: To curtail the opioid epidemic, physicians have been advised to limit opioid prescriptions.

Objective: To characterize the frequency and changes over time (2009-2020) of opioid prescriptions following Mohs micrographic surgery.

Design, setting, and participants: This cross-sectional study using Optum Clinformatics DataMart (Optum CDM), a nationally representative insurance claims database, included patients aged 18 years and older who had Mohs micrographic surgery insurance claims in the Optum CDM database from 2009 to 2020. Data were analyzed from November 11, 2020, to March 30, 2021.

Exposures: Opioid prescription following Mohs surgery.

Main outcomes and measures: The primary outcome was the proportion of patients who underwent Mohs surgery and obtained an opioid prescription within 2 days of surgery. Secondary outcomes included type and opioid quantity prescribed.

Results: Among 358 012 patients with Mohs micrographic surgery claims (mean [SD] age, 69 [13] years; 205 609 [57.4%] were men), the proportion of patients obtaining an opioid prescription after Mohs micrographic surgery increased from 2009 (34.6%) to 2011 (39.6%). This proportion then declined each year, reaching a low of 11.7% in 2020 (27.9% absolute decrease from 2011 to 2020). Hydrocodone, codeine, oxycodone, and tramadol were the 4 most commonly prescribed opioids. By 2020, hydrocodone was obtained less (2009: 47.5%; 2011: 67.1%; 2020: 45.4%; 21.7% absolute decrease from 2011 to 2020) and tramadol was obtained more (2009: 1.6%; 2020: 27.9%; 26.3% absolute increase from 2009 to 2020).

Conclusions and relevance: In this cross-sectional study of Mohs micrographic surgery claims, patients obtained fewer postsurgery opioid prescriptions over the study period, suggesting responsiveness of patients and dermatologic surgeons to public health concerns regarding the opioid epidemic. During this decline, prescriptions for hydrocodone decreased and tramadol increased.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Etzkorn is supported by a Dermatology Foundation Career Development Award in Dermatologic Surgery. Dr Noe reported receiving grants from Boehringer Ingelheim outside the submitted work. Dr Shin reported receiving grants from Regeneron outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Percentage of Patients Who Underwent Mohs Micrographic Surgery (MMS) With an Opioid Prescription Obtained by Year, 2009 to 2020
Figure 2.
Figure 2.. Opioid Active Ingredient Relative Frequency by Year, 2009 to 2020
Other refers to opioids containing hydromorphone, morphine, fentanyl, meperidine, tapentadol, oxymorphone, and pentazocine.
See this image and copyright information in PMC

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