Opioid Prescriptions and Pain-Related Patient-Initiated Communication After Mohs Micrographic Surgery: A Retrospective Cohort Study

May 2022 | Volume 21 | Issue 5 | 551 | Copyright © May 2022


Published online May 1, 2022

doi:10.36849/JDD.5742

Christian Carr , Oliver Taylor , Antonio Garcia , Sophia Tran , Divya Srivastava , Rajiv I Nijhawan

Department of Dermatology, University of Texas Southwestern Medical School, Dallas, TX

Abstract
Background: There is a wide variety in utilization of opioids during Mohs Micrographic Surgery (MMS) despite evidence that a multimodality approach may be more beneficial.
Objective: To evaluate prescription opioid use at our institution and subsequent pain-related patient communication following MMS.
Methods: This was a retrospective cohort study involving 2360 patients who underwent MMS. Patient and operative characteristics in relation to opioid use in the peri-operative period were compared using univariate and bivariate statistical measures.
Results: A total of 306 patients (13%) were prescribed opioids postoperatively. However, receipt of opioids is associated with greater odds of pain-related patient communication (OR=6.2; 95% CI:3.3–11.4). Opioid type was not significantly associated with reported pain (OR=0.7; 95% CI:0.3–1.8).
Conclusion: Consistent with existing guidelines, certain patient and operative characteristics such as age, number of Mohs stages, repair type, and anatomic site were associated with greater odds of receiving opioids. While certain patients may require opioids for adequate pain control, in our cohort, opioid use was associated with increased odds of pain-related patient communication post MMS.

J Drugs Dermatol. 2022;21(5):551-554. doi:10.36849/JDD.5742

INTRODUCTION

Mohs micrographic surgery (MMS) is typically associated with mild to moderate pain on the day of surgery and first postoperative day that is often well-managed with over the counter analgesics.1 However, dermatologists’ practice patterns regarding prescription pain medications vary.2,3 Anatomic site, repair size/type, and patient pain tolerance should be considered if/when deciding to prescribe opioids.4,5 Of note, postoperative pain has been reported to be the third most common reason patients initiate communication after MMS.6 This study reviews our institution’s opioid prescribing practice while examining pain-related patientinitiated communication after MMS. We hypothesized that painrelated communication is infrequent following MMS with multimodality analgesia (eg, rest, ice, alternating acetaminophen with non-steroidal anti-inflammatory, etc.) and judicious use of opioids.

MATERIALS AND METHODS

Retrospective chart review was performed of 2360 patients with 2770 lesions who underwent MMS at a single institution with two surgeons over the course of 17 months (2017-2018). Data collected included demographics, operative characteristics, opioid prescriptions prescribed, and follow-up pain-related patient concerns. Of note, an attempt is made the evening postsurgery to contact all patients to assess for concerns. If significant concerns for pain are noted, we follow expert consensus guidelines to determine whether an opioid prescription may be of benefit to the patient. If a decision is made to prescribe opioids, no more than three days (6-10 tablets) are given. Univariate and bivariate measures were used to evaluate the sample. Alpha <0.05 was used to determine significance. All analyses were performed using SAS 9.4.

RESULTS

Table 1 includes summary statistics and bivariate odds ratios for demographics and operative characteristics. Briefly, 306 patients (13.0%) were prescribed opioids post-operatively. Hydrocodone-acetaminophen 5-325 mg (n=190) was more commonly prescribed than tramadol 50 mg (n=116), although tramadol was more often given to ages >74 (n=56, 53.8%). Ages 22–40 were most likely to receive opioids post-operatively [OR=2.5; 95% CI=1.1–6.0]. Gender was not associated with opiate prescriptions.
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