SA1 - Does Oral and Maxillofacial Surgeon Experience Affect Opioid Prescriptions to Medicare Recipients?

Abstract:

Purpose: Oral and maxillofacial surgeons have prescribed fewer opioid analgesics in recent years. These changes have occurred in the context of governmental and institutional interventions to reduce opioid over-prescribing. Research in other surgical subspecialities have found that surgeon experience, or years in practice (YIP), is associated with opioid prescribing patterns, though this is not well studied among oral and maxillofacial surgeons. As such, the purpose of this study was to examine if surgeon experience is associated with differences in opioid prescription patterns in OMS.

Methods
This study used publicly available Medicare Provider Utilization and Payment Data from 2022. It included all providers with specialty labeled as OMS. National Provider Identification (NPI) numbers were cross-referenced with the National Plan and Provider Enumeration System (NPPES) registry to identify the enumeration date to calculate the YIP as of 2022, which was the primary predictor variable. YIP was calculated assuming the NPI was obtained the year of dental school graduation, given that it has been a requirement for Medicare prescription since 2008. YIP was categorized into 0-3 years (2019-2022), 4-8 years (2014-2018), 9-13 years (2009-2013), and ≥14 years (2008 or prior). Surgeons with YIP of ≥14 years were grouped because many OMSs already in practice obtained NPIs around the time of the mandate. Outcome variables were opioid prescriptions per Medicare beneficiary, days supply of opioids per prescription, and opioid prescription rate (Percentage of all annual prescriptions that are opioids). Descriptive statistics, Kruskal-Wallis test with Dunn-Bonferroni post hoc test, and multiple linear regression (with YIP as a continuous variable) were performed to analyze outcome variables.

Results: The study sample consisted of 7,097 oral and maxillofacial surgeons who submitted a Medicare prescription claim in 2022. Of the cohort, 6,249 (88%) oral and maxillofacial surgeons were male. Oral and maxillofacial surgeons had a mean of 143.9 Medicare beneficiaries, of whom 55.7% were female with a mean age of 71.9 years. There were 563,536 total opioid prescriptions, with mean of 1.0 prescription per beneficiary and 2.6 days’ supply per prescription. The mean opioid prescription rate per prescriber was 23.8%. OMSs with YIP 0-3 years had significantly fewer opioid claims per beneficiary (0.8 vs >1.0 for other YIP categories, P < .01) and had a lower opioid prescription rate (14.6% vs >21.5% for other YIP categories, P < .01). Multiple linear regression showed that the opioid prescription rate was positively associated with YIP (β = 0.20; 95% CI: 0.19-0.39; R2 = 0.26)

Conclusions: This study found that OMS experience is associated with differential opioid prescribing patterns to Medicare recipients from 2022. Specifically, oral and maxillofacial surgeons who have been in practice longer had more opioid claims per beneficiaries and higher opioid prescription rates than those with fewer YIP. These findings may be attributable to variation in pain management education in dental school and residency and/or differential impacts of recent opioid-related public health interventions. It is also plausible that more experienced surgeons are performing more invasive surgical procedures thus requiring additional post-operative analgesia. Further investigation is warranted to evaluate if surgeon experience is associated with prescription patterns to the general patient population, as well as the rate change in prescription habits in recent years.