Researchers identify factors linked between opioid prescription, skin cancer treatment

Data show that certain characteristics can determine the likelihood of opioid prescriptions following Mohs micrographic surgery, but these prescriptions may not be necessary, according to a study.

Christian Carr, MPH, of the University of Texas Southwestern Medical School, and colleagues noted that Mohs micrographic surgery (MMS) is typically associated with mild to moderate pain on the day of surgery and first postoperative day, which are generally managed with over-the-counter analgesics. These pain treatments can vary, however.

To evaluate prescription opioid use and subsequent pain-related communication, Carr and colleagues conducted a retrospective study of 2,360 patients seen at their institution who underwent MMS.

Of the 306 patients prescribed opioids postoperatively, 190 received hydrocodone-acetaminophen and 116 received tramadol. Tramadol was more often given to patients aged older than 74 years.

Factors that led to 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 with linear repair (OR = 2.4; 95% CI, 1.5-3.9) and surgical site on nose (OR = 1.7; 95% 1.2-2.3) or lip (OR = 4; 95%; 95% CI, 2.1-7.4).

In contrast, secondary intention healing correlated with lower odds of receiving prescription opioids. Similarly, surgeries that involved treating multiple lesions on the same day did not correlate with receipt of opioids.

The only surgical site correlated with increased report of pain compared with the face was the ear (OR = 2.2; 95% CI, 1.04-4.8).

“Our findings confirm that most patients do not require opioid prescriptions,” Carr and colleagues wrote. “Interestingly, in our cohort, opioid prescriptions were significantly associated with subsequent pain concerns, indicating that patients at higher risk of reporting pain are being appropriately identified.”