Increased odds of prescription analgesics included utilization of single stage flap [OR=5.9; 95% CI:4.5–7.8], pedicle flap [OR=9.1; 95% CI:4.5–18.4], and skin graft compared to linear repair [OR=2.4; 95% CI:1.5–3.9], surgical site on the nose [OR=1.7; 95% CI:1.2– 2.3] and lip [OR=4.0, 95% CI:2.1–7.4] compared to other parts of the face, extirpation of melanoma in situ compared to basal cell carcinoma [OR=1.8, 95% CI:1.2–2.8], increasing Mohs stages, and larger defect size. In contrast, secondary intention healing was associated with lower odds of receiving a prescription for opioids [OR=0.6; 95% CI:0.4–0.9]. Surgery involving multiple lesions on the same day was not significantly associated with receipt of opioids [OR=1.2; 95% CI:0.9–1.7].
Of the 306 patients who received opioids on the day of surgery, 20 (6.5%) [OR=6.2;95%CI:3.3-11.4] called with concerns of pain versus 23 (1.1%) patients who did not receive opioids. The only surgical site associated with increased report of pain compared to the face was the ear [OR=2.2; 95% CI:1.04, -4.8]. Type of opioid prescribed was not significantly associated with post-surgery report of pain [OR=0.7; 95% CI:0.3-1.8].
CONCLUSION
Certain characteristics such as age, repair type, Mohs stages, and
different anatomic sites likely increase the odds of prescribing
opioids post-MMS and patient calls with pain concerns. Our
findings confirm that most patients do not require opioid
prescriptions. Interestingly, in our cohort, opioid prescriptions
were significantly associated with subsequent pain concerns
