title: Opioid prescribing patterns after Mohs micrographic surgery and standard excision: a survey of American Society for Dermatologic Surgery members and a chart review at a single institution.
abstract: BACKGROUND
  Little is known about postoperative opioid prescribing patterns among dermatologic surgeons.
  
  
  OBJECTIVE
  To better understand postoperative opioid prescribing patterns among dermatologic surgeons in the United States.
  
  
  METHODS
  Two-part analysis consisting of a retrospective chart review of 233 dermatologic surgery patients at a single institution and an e-mail survey of American Society for Dermatologic Surgery (ASDS) members.
  
  
  RESULTS
  (1) Retrospective review: 35% (82/233) of the patients received an opioid prescription. Larger defect size, repair of the defect, perioral and nasal site, and surgeon A or B performing surgery predicted opioid prescription. (2) E-mail survey: 556 ASDS members practicing within the United States responded. Sixty-four percent (357/556) reported prescribing opioids after ≤10% of cases. Surgeons younger than 55 years old, male surgeons, and surgeons in the southern and western United States were more likely to prescribe opioids after >10% of cases. Seventy-six percent (397/520) believed patients used ≤50% of the opioid pills prescribed.
  
  
  CONCLUSIONS
  The retrospective review suggests that opioid prescribing is predicted by characteristics of the surgery (i.e., size, defect repair type, and anatomic location) and characteristics of the surgeon (i.e., age, sex, and practice location) with significant heterogeneity in prescribing habits. The national survey results raise the possibility that patients might not take all prescribed opioid pills after dermatologic surgery. Further investigation is warranted to determine how patients are actually using prescription pain pills to balance pain control with patient safety.
authors.affiliation: †Deceased; *Department of Dermatology, University of Utah, Salt Lake City, Utah; and ‡Department of Dermatology, University of Wisconsin, Madison, Wisconsin.
authors.forename: Kalynne
authors.initials: K
authors.lastname: Harris
authors.forename: Scott
authors.initials: S
authors.lastname: Calder
authors.forename: Brooke
authors.initials: B
authors.lastname: Larsen
authors.forename: Keith
authors.initials: K
authors.lastname: Duffy
authors.forename: Glen
authors.initials: G
authors.lastname: Bowen
authors.forename: Payam
authors.initials: P
authors.lastname: Tristani-Firouzi
authors.forename: Michael
authors.initials: M
authors.lastname: Hadley
authors.forename: Justin
authors.initials: J
authors.lastname: Endo
mesh_terms: D000082:Acetaminophen / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D002280:Basal Cell Carcinoma / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003061:Codeine / Q000627:therapeutic use; D004338:Drug Combinations; D005153:Facial Neoplasms / Q000601:surgery*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D006853:Hydrocodone / Q000627:therapeutic use; D008297:Male; D008545:Melanoma / Q000601:surgery; D008875:Middle Aged; D015580:Mohs Surgery / Q000009:adverse effects*; D010098:Oxycodone / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011365:Professional Practice Location; D012189:Retrospective Studies; D012737:Sex Factors; D012878:Skin Neoplasms / Q000601:surgery*; D012955:Societies, Medical; D014481:United States
chemical_list: D000701:Analgesics, Opioid; D004338:Drug Combinations; C526278:acetaminophen, codeine drug combination; C083640:acetaminophen, hydrocodone drug combination; C514822:oxycodone-acetaminophen; D000082:Acetaminophen; D006853:Hydrocodone; D010098:Oxycodone; D003061:Codeine