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Jeha GM, Malinosky HR, Taylor L, Greenway HT, Kelley B. Liposomal and Nonliposomal Bupivacaine for Mohs Surgery: A Systematic Review. Dermatol Surg 2024; 50:16-20. [PMID: 37861355 DOI: 10.1097/dss.0000000000003981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
BACKGROUND Lidocaine is the most commonly used local anesthetic for Mohs micrographic surgery (MMS), but given its limited half-life, postoperative pain remains a significant concern for patients. Bupivacaine is used in various surgical subspecialty procedures and has demonstrated improved pain control compared with lidocaine. However, its role in MMS is insufficiently explored. OBJECTIVE To systematically review the current literature for reports on use of bupivacaine, traditional nonliposomal and newer liposomal formulations, for MMS. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The MEDLINE, PubMed, and EMBASE databases were queried for articles presenting original data on the use of bupivacaine for MMS. RESULTS Of 483 potentially relevant articles, 3 studies met final inclusion criteria, capturing a total of 253 patients involved in primary investigations comparing bupivacaine to traditional local anesthesia for MMS. Bupivacaine was well-tolerated and associated with comparable or modestly reduced intraoperative and postoperative pain and opioid use. CONCLUSION Bupivacaine may have a role in prolonging intraoperative anesthesia, reducing acute postoperative pain, and reducing postoperative opioid use after MMS. However, large, prospective studies are needed to solidify the generalizability and clinical utility of these findings.
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Affiliation(s)
- George M Jeha
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Hannah R Malinosky
- Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Laura Taylor
- Bighorn Mohs Surgery and Dermatology Center, Scripps Clinic, La Jolla, California
| | - Hubert T Greenway
- Bighorn Mohs Surgery and Dermatology Center, Scripps Clinic, La Jolla, California
| | - Benjamin Kelley
- Bighorn Mohs Surgery and Dermatology Center, Scripps Clinic, La Jolla, California
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2
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Gangal A, Stoff B, Blalock T. The 2022 CDC opioid prescription guideline update: Relevant recommendations and future considerations. JAAD Int 2023; 13:48-49. [PMID: 37674776 PMCID: PMC10477793 DOI: 10.1016/j.jdin.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Affiliation(s)
- Ameya Gangal
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Benjamin Stoff
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
- Emory Center for Ethics, Atlanta, Georgia
| | - Travis Blalock
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
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Cronin WA, Nealeigh MD, Harry NM, Kerr C, Cyr KL, Velosky AG, Highland KB. Appendectomy Pain Medication Prescribing Variation in the U.S. Military Health System. Mil Med 2023:usad419. [PMID: 37951595 DOI: 10.1093/milmed/usad419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/14/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
INTRODUCTION Post-appendectomy opioid prescription practices may vary widely across and within health care systems. Although guidelines encourage conservative opioid prescribing and prescribing of non-opioid pain medications, the variation of prescribing practices and the probability of opioid refill remain unknown in the U.S. Military Health System. MATERIALS AND METHODS This retrospective observational cohort study evaluated medical data of 11,713 patients who received an appendectomy in the Military Health System between January 2016 and June 2021. Linear-mixed and generalized linear-mixed models evaluated the relationships between patient-, care-, and system-level factors and the two primary outcomes; the morphine equivalent dose (MED) at hospital discharge; and the probability of 30-day opioid prescription refill. Sensitivity analyses repeated the generalized linear-mixed model predicting the probability of opioid (re)fill after an appendectomy, but with inclusion of the full sample, including patients who had not received a discharge opioid prescription (e.g., 0 mg MED). RESULTS Discharge MED was twice the recommended guidance and was not associated with opioid refill. Higher discharge MED was associated with opioid/non-opioid combination prescription (+38 mg) relative to opioid-only, lack of non-opioid prescribing at discharge (+6 mg), care received before a Defense Health Agency opioid safety policy was released (+61 mg), documented nicotine dependence (+8 mg), and pre-appendectomy opioid prescription (+5 mg) (all P < .01). Opioid refill was more likely for patients with complicated appendicitis (OR = 1.34; P < .01); patients assigned female (OR = 1.25, P < .01); those with a documented mental health diagnosis (OR = 1.32, P = .03), an antidepressant prescription (OR = 1.84, P < .001), or both (OR = 1.54, P < .001); and patients with documented nicotine dependence (OR = 1.53, P < .001). Opioid refill was less likely for patients who received care after the Defense Health Agency policy was released (OR = 0.71, P < .001), were opioid naive (OR = 0.54, P < .001), or were Asian or Pacific Islander (relative to white patients, OR = 0.68, P = .04). Results from the sensitivity analyses were similar to the main analysis, aside from two exceptions. The probability of refill no longer differed by race and ethnicity or mental health condition only. CONCLUSIONS Individual prescriber practices shifted with new guidelines, but potentially unwarranted variation in opioid prescribing dose remained. Future studies may benefit from evaluating patients' experiences with pain management, satisfaction, and patient-centered education after appendectomy within the context of opioid prescribing practices, amount of medications used, and refill probability. Such could pave a way for standardized patient-centered procedures that both decrease unwarranted prescribing pattern variability and optimize pain management regimens.
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Affiliation(s)
- William A Cronin
- Department of Anesthesiology, Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD 20814, USA
- Department of Anesthesiology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Matthew D Nealeigh
- Department of Surgery, Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD 20814, USA
- Department of Surgery, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Nathaniel M Harry
- Department of Anesthesiology, Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD 20814, USA
| | - Christopher Kerr
- Department of Anesthesiology, Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD 20814, USA
| | - Kyle L Cyr
- Department of Anesthesiology, Walter Reed National Military Medical Center, 4494 Palmer Rd N, Bethesda, MD 20814, USA
- Department of Anesthesiology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Alexander G Velosky
- Defense and Veterans Center for Integrative Pain Management, Department of Anesthesiology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr., #100, Bethesda, MD 20817, USA
- Enterprise Intelligence and Data Solutions (EIDS) Program Office, Program Executive Office, Defense Healthcare Management Systems (PEO DHMS), 3515 S. General McMullen, Building 1, San Antonio, TX 78226, USA
| | - Krista B Highland
- Department of Anesthesiology, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
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Dickerson DM, Mariano ER, Szokol JW, Harned M, Clark RM, Mueller JT, Shilling AM, Udoji MA, Mukkamala SB, Doan L, Wyatt KEK, Schwalb JM, Elkassabany NM, Eloy JD, Beck SL, Wiechmann L, Chiao F, Halle SG, Krishnan DG, Cramer JD, Ali Sakr Esa W, Muse IO, Baratta J, Rosenquist R, Gulur P, Shah S, Kohan L, Robles J, Schwenk ES, Allen BFS, Yang S, Hadeed JG, Schwartz G, Englesbe MJ, Sprintz M, Urish KL, Walton A, Keith L, Buvanendran A. Multiorganizational consensus to define guiding principles for perioperative pain management in patients with chronic pain, preoperative opioid tolerance, or substance use disorder. Reg Anesth Pain Med 2023:rapm-2023-104435. [PMID: 37185214 DOI: 10.1136/rapm-2023-104435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023]
Abstract
Significant knowledge gaps exist in the perioperative pain management of patients with a history of chronic pain, substance use disorder, and/or opioid tolerance as highlighted in the US Health and Human Services Pain Management Best Practices Inter-Agency Task Force 2019 report. The report emphasized the challenges of caring for these populations and the need for multidisciplinary care and a comprehensive approach. Such care requires stakeholder alignment across multiple specialties and care settings. With the intention of codifying this alignment into a reliable and efficient processes, a consortium of 15 professional healthcare societies was convened in a year-long modified Delphi consensus process and summit. This process produced seven guiding principles for the perioperative care of patients with chronic pain, substance use disorder, and/or preoperative opioid tolerance. These principles provide a framework and direction for future improvement in the optimization and care of 'complex' patients as they undergo surgical procedures.
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Affiliation(s)
- David M Dickerson
- Department of Anesthesiology, Critical Care and Pain Medicine, NorthShore University HealthSystem, Evanston, Illinois, USA
- Department of Anesthesia & Critical Care, University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Edward R Mariano
- Anesthesiology and Perioperative Care Service, VA Palo Alto Health Care System, Palo Alto, California, USA
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Joseph W Szokol
- Department of Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA
| | - Michael Harned
- Department of Anesthesiology, Division of Pain Medicine, University of Kentucky, Lexington, Kentucky, USA
| | - Randall M Clark
- American Society of Anesthesiologists, Park Ridge, Illinois, USA
| | - Jeffrey T Mueller
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Ashley M Shilling
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Mercy A Udoji
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, Georgia, USA
- Atlanta VA Health Care System, Decatur, Georgia, USA
| | | | - Lisa Doan
- Department of Anesthesiology, PerioperativeCare and Pain Medicine, New York University School of Medicine, New York, New York, USA
| | - Karla E K Wyatt
- Department of Anesthesiology, Perioperativeand Pain Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Jason M Schwalb
- Department of Neurosurgery, Henry Ford Medical Group, Detroit, Michigan, USA
| | - Nabil M Elkassabany
- Department of Anesthesiology, University of Virginia Health System, Charlottesville, Virginia, USA
| | - Jean D Eloy
- Department of Anesthesiology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Stacy L Beck
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Maternal Fetal Medicine, University of Pittsburgh Medical Center Health System, Pittsburgh, Pennsylvania, USA
| | - Lisa Wiechmann
- Department of Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York, New York, USA
| | - Franklin Chiao
- Department of Anesthesiology, Westchester Medical Center, Valhalla, New York, USA
| | - Steven G Halle
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Deepak G Krishnan
- Department of Oral & Maxillofacial Surgery, University of Cincinnati Medical Center, Cincinnati, Ohio, USA
- Department of Oral & Maxillofacial Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - John D Cramer
- Department of Otolaryngology - Head and Neck Surgery, Wayne State University, Detroit, Michigan, USA
| | - Wael Ali Sakr Esa
- Department of Pain Management, Cleveland Clinic, Cleveland, Ohio, USA
| | - Iyabo O Muse
- Department of Anesthesiology, Montefiore Medical Center, Bronx, New York, USA
- Department of Anesthesiology, Westchester Medical Center Health Network, Valhalla, New York, USA
| | - Jaime Baratta
- Department of Anesthesiology and Perioperative Medicine, Thomas Jefferson University Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | | | - Padma Gulur
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Shalini Shah
- Department of Anesthesiology and Perioperative Care, University of California Irvine, Orange, California, USA
| | - Lynn Kohan
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia, USA
| | - Jennifer Robles
- Department of Urology Division of Endourology and Stone Disease, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Surgical Service, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee, USA
| | - Eric S Schwenk
- Department of Anesthesiology and Perioperative Medicine, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian F S Allen
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Stephen Yang
- Department of Surgery, Division of Thoracic Surgery, Johns Hopkins Medical Institutions Campus, Baltimore, Maryland, USA
| | | | - Gary Schwartz
- AABP Integrative Pain Care, Melville, New York, USA
- Maimonides Medical Center, Brooklyn, New York, USA
| | | | - Michael Sprintz
- Sprintz Center for Pain and Recovery, Shenandoah, Texas, USA
| | - Kenneth L Urish
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ashley Walton
- American Society of Anesthesiologists, Washington, District of Columbia, USA
| | - Lauren Keith
- American Society of Anesthesiologists, Park Ridge, Illinois, USA
| | - Asokumar Buvanendran
- Department of Anesthesiology, Rush University Medical Center, Chicago, Illinois, USA
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5
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Voss VB, Oh C, Veerabagu S, Nugent S, Giordano C, Golda NJ. Bupivacaine to Reduce Pain and Narcotic Use After Mohs Micrographic Surgery. Dermatol Surg 2022; 48:1135-1139. [PMID: 36342245 DOI: 10.1097/dss.0000000000003567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Limited data exists for bupivacaine injection after Mohs micrographic surgery (MMS). OBJECTIVE Evaluate how bupivacaine affects postoperative pain and narcotic use. MATERIALS AND METHODS In this multicenter, single-blinded, prospective randomized controlled trial, patients received bupivacaine or saline (placebo) immediately after MMS with flap reconstructions identified by American Academy of Dermatology expert consensus as high-risk for pain and narcotic use. For 48 hours postoperatively, patients logged analgesic use, pain scores (0-10), and whether pain was controlled. RESULTS One hundred seventy-four patients were included. Narcotic analgesic use was higher in the placebo group during the first 24 hours (odds ratio 2.18; confidence interval [CI]: 1.08-4.41; p = .03), second 24 hours (odds ratio 2.18; CI: 0.91-5.29; p = .08), and 48 hours combined (odds ratio 2.58; CI: 1.28-5.24; p < .01). Pain scores were lower in the bupivacaine group during the first 8 hours (mean difference 1.6; CI: 0.73-2.38; p < .001). Overall analgesic use (narcotic and non-narcotic) and percentage of patients reporting pain under control were similar between groups. There were no significant differences in demographics or surgical characteristics. No adverse events occurred. CONCLUSION Single-dose bupivacaine decreased postoperative pain and narcotic analgesic use after MMS with reconstructions likely to cause significant pain. Bupivacaine may have a role in postoperative pain management and reducing narcotic use in this population.
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Affiliation(s)
- Vanessa B Voss
- Department of Dermatology, University of Missouri, Columbia, Missouri
| | - Clara Oh
- Department of Dermatology, University of Missouri, Columbia, Missouri
| | - Surya Veerabagu
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Shannon Nugent
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Cerrene Giordano
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Nicholas J Golda
- Department of Dermatology, University of Missouri, Columbia, Missouri
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Practice Patterns for Mohs Surgeons of Varying Clinical Experience: A Cross-Sectional Analysis of a Medicare Claims Database. Dermatol Surg 2022; 48:1029-1032. [PMID: 36095278 DOI: 10.1097/dss.0000000000003562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Use of Mohs micrographic surgery (MMS) is highly prevalent, but little data are available on how surgeon experience affects surgical practice patterns. OBJECTIVE To determine differences in use of MMS among surgeons of varying experience. MATERIALS AND METHODS This cross-sectional study sampled from clinicians billing ≥200 mean annual Mohs surgery claims from the 2012 to 2018 Medicare Public Use File. The primary outcome was mean annual Mohs surgery claims for clinicians of varying experience. Secondary outcomes included use of flaps/grafts and prescribing of oral antibiotics, benzodiazepines, and opioids. RESULTS Among 1,759 unique surgeons, those with 16 to 20 years of experience performed the most mean annual (95% confidence interval) Mohs surgical cases (578.7 [556.7-600.6]). Surgeons with 21 to 25 years of experience prescribed the most antibiotics (240.2 [216.5-263.8] mean annual claims), whereas those with >35 years of experience prescribed the longest courses (15.3 [14.2-16.4] days). CONCLUSION Midcareer surgeons performed the most mean annual Mohs surgery cases, whereas later career surgeons prescribed more frequent and longer courses of antibiotics suggesting changing practice patterns with additional years of experience.
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7
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Pourali SP, Gutierrez Y, Jones ME, Rajkumar JR, Kucharik AH, Armstrong AW. Are we contributing to the opioid epidemic? A systematic review on systemic opioid use in dermatology. Int J Dermatol 2022; 61:1056-1068. [PMID: 34870325 DOI: 10.1111/ijd.16011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/11/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although dermatologists treat many painful skin conditions and perform procedures that may require analgesic use, there is a lack of evidence synthesis on opioid use in dermatology. OBJECTIVE To conduct a systematic review of the evidence on the use of opioid analgesics in dermatology. METHODS We applied the PRISMA guidelines and systematically reviewed literature that examined opioid use in dermatology published between 1980 and 2020 in the PubMed, EMBASE, and Cochrane databases. This review was registered with PROSPERO (CRD42020204864). RESULTS We identified 24 studies that analyzed 52,705,201 patients and 13,099 dermatologists. Between 34% and 87.5% of patients received opioids following dermatologic procedures; however, many did not use the entirety of their prescriptions, and 35-69% did not use any of their prescription. Top opioid prescribers were more likely to be Mohs surgeons, male, and practice in the South. Variability exists in the current evidence for opioid prescribing for nonprocedural dermatologic disease. CONCLUSION While opioid prescribing in dermatology is low compared with other specialties, patients are not utilizing the entirety of their prescriptions. Opioid prescribing for nonprocedural dermatologic disease varies; treatments focused on targeting the pathogenesis of these diseases is important to minimize opioid use. Dermatologists should consider limiting opioid prescribing and utilizing nonnarcotic analgesics.
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Affiliation(s)
- Sarah P Pourali
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Yasmin Gutierrez
- University of California Riverside School of Medicine, Riverside, CA, USA
| | - Madison E Jones
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Alison H Kucharik
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - April W Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Veerabagu SA, Yanes AF, Cheng B, Etzkorn JR, Miller CJ, Shin TM, Sobanko JF, Higgins HW, McMurray SL, Walker JL, Giordano CN. Dermatologic Surgery Opioid Recommendation Guidelines in Practice. J Am Acad Dermatol 2021; 87:492-494. [PMID: 34838880 DOI: 10.1016/j.jaad.2021.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/15/2021] [Accepted: 11/17/2021] [Indexed: 11/17/2022]
Affiliation(s)
| | - Arianna F Yanes
- Department of Dermatology; Hospital of the University of Pennsylvania; Philadelphia, PA, USA
| | - Brian Cheng
- University of South Carolina School of Medicine; Columbia, SC, USA
| | - Jeremy R Etzkorn
- Department of Dermatology; Hospital of the University of Pennsylvania; Philadelphia, PA, USA
| | - Christopher J Miller
- Department of Dermatology; Hospital of the University of Pennsylvania; Philadelphia, PA, USA
| | - Thuzar M Shin
- Department of Dermatology; Hospital of the University of Pennsylvania; Philadelphia, PA, USA
| | - Joseph F Sobanko
- Department of Dermatology; Hospital of the University of Pennsylvania; Philadelphia, PA, USA
| | - H William Higgins
- Department of Dermatology; Hospital of the University of Pennsylvania; Philadelphia, PA, USA
| | - Stacy L McMurray
- Department of Dermatology; Hospital of the University of Pennsylvania; Philadelphia, PA, USA
| | - Joanna L Walker
- Department of Dermatology; Hospital of the University of Pennsylvania; Philadelphia, PA, USA
| | - Cerrene N Giordano
- Department of Dermatology; Hospital of the University of Pennsylvania; Philadelphia, PA, USA
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Veerabagu SA, Cheng B, Wang S, Etzkorn JR, Kilaru AS, Noe MH, Miller CJ, Sobanko JF, Shin TM, Higgins HW, McMurray SL, Krausz AE, Walker JL, Giordano CN. Rates of Opioid Prescriptions Obtained After Mohs Surgery: A Claims Database Analysis From 2009 to 2020. JAMA Dermatol 2021; 157:1299-1305. [PMID: 34550299 DOI: 10.1001/jamadermatol.2021.3468] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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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Affiliation(s)
| | - Brian Cheng
- University of South Carolina School of Medicine, Columbia
| | - Sonia Wang
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jeremy R Etzkorn
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Austin S Kilaru
- Department of Emergency Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Megan H Noe
- Department of Dermatology, Brigham and Women's Hospital, Harvard School of Medicine, Boston, Massachusetts
| | - Christopher J Miller
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Joseph F Sobanko
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Thuzar M Shin
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - H William Higgins
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Stacy L McMurray
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Aimee E Krausz
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Joanna L Walker
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
| | - Cerrene N Giordano
- Department of Dermatology, Hospital of the University of Pennsylvania, Philadelphia
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10
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Commentary on Benzodiazepine Utilization in Medicare Beneficiaries by Mohs Surgeons and Dermatologists From 2013 to 2017. Dermatol Surg 2021; 47:834-835. [PMID: 34029253 DOI: 10.1097/dss.0000000000002872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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11
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Winsett F, Gleghorn K, Croley J, Wagner RF. Managing pain associated with dermatologic procedures. Int J Dermatol 2021; 60:e480-e485. [PMID: 33739460 DOI: 10.1111/ijd.15540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/15/2021] [Accepted: 02/26/2021] [Indexed: 11/30/2022]
Abstract
Dermatologists are faced with an aging population, accompanied by an increase in the incidence of skin cancer, especially nonmelanoma skin cancer. With this increase in cutaneous malignancy comes an increase in the number of dermatologic procedures being performed. A common concern of dermatologists and dermatology patients is the attenuation and management of pain associated with dermatologic procedures. Fortunately, there are several techniques that may be used in the preoperative, intraoperative, and postoperative periods to manage patient anxiety, minimize injection pain, and safely and effectively treat postoperative pain.
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Affiliation(s)
- Frank Winsett
- Department of Dermatology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Kristyna Gleghorn
- Department of Dermatology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Julie Croley
- Department of Dermatology, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Richard F Wagner
- Department of Dermatology, The University of Texas Medical Branch, Galveston, Texas, USA
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