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]).
Clinical Pearls
Midcareer surgeons performed the most annual mean Mohs surgery cases
Benzodiazepine use was low overall, but most often prescribed by later career surgeons (26-30 years of experience)
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])
Discussion:
As the incidence of nonmelanoma skin cancers has risen, there has been a consequent increase in the supply of fellowship and non-fellowship–trained Mohs micrographic (MMS) surgeons. Previous studies have noted variation in surgical volume and prescribing practices for perioperative antibiotic prophylaxis in addition to the use of benzodiazepines. The purpose of this study was to investigate whether practice patterns change with surgeon experience
Data was deidentified, publicly available and extracted from the 2012 to 2018 Medicare Public Use File and Physician Compare. Surgeon experience was divided into 5-year intervals (1–5 years in practice, 6–10 years, etc). Surgeons will be referred to as either early (1–10 years in practice), mid (11–25 years), or late (26+ years) career clinicians. Multivariable linear regression models were used to determine statistically significant association between mean annual MMS claims, proportion of head/ neck cases, proportion of flap/graft repairs, and mean annual claims/treatment courses for oral antibiotics/ benzodiazepines/opioids compared with surgeon experience.
This study’s population evaluated 1,759 surgeons performing at least 200 annual MMS cases. Early to mid-career surgeons performed the most (95% CI, p value compared with the reference group of surgeons with 1–5 years’ experience) annual MMS cases with the highest volume for those in practice for 16 to 20 years (578.7 [556.7–600.6] claims, p= .001). Early to midcareer surgeons prescribed the most oral antibiotics per year, when compared to the reference group. Benzodiazepines were prescribed less frequently compared to antibiotics, with later career surgeons (26-30 years’ experience) prescribing them most often (165.6 [37.8–293.4] claims, p < .001). Opioid use was also low overall in this sample, and when controlling for confounders, there was no significant association between surgeon experience and opioid claims or treatment course duration.
This study includes a nationally representative sample with large sample size investigating a relevant topic in dermatologic surgery. Major limitations of the study include the lack of data on tumor characteristics, patient demographics, or external validity for non-Medicare fee-for-service patients.
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