Disparities and longitudinal complications in opioid prescriptions after dermatologic surgery: An international propensity score-matched, retrospective cohort study.

Background: In dermatology, the majority of opioid prescriptions occur in dermatologic surgery. Even short courses of opioids are linked to substance abuse. Reported rates of opioid prescription in dermatologic surgery are variable, with no consensus on when they should be prescribed. Little population data currently exists on opioids in dermatologic surgery and the potentially serious complications that result. Here, we use an international patient data network to evaluate trends in postoperative opioid prescription in the setting of dermatologic surgery and complications that may result.

Methods: This retrospective cohort study analyzed patients within the TriNetX research network. A total of 1,160,223 dermatologic surgery patients were extracted. Risk analyses were conducted examining (1) oral opioid prescription within 2 days postsurgery; (2) adverse events related to opioid use 3 months to 5 years postsurgery. Propensity score matching included variables: age, gender, race, ethnicity, complex regional pain syndrome, back pain, osteoarthritis, and malignancy.

Results: A total of 124,292 (13.6%) patients received postsurgical opioids. Black or African American race, female gender, and Latino ethnicity were associated with significantly higher absolute risk of postsurgical opioid prescription. A positive history of prior opioid prescription, opioid abuse or dependence, or substance abuse yielded a significant increase in the absolute risk of receiving postsurgical opioids (P < 0.0001). Patients prescribed postsurgical opioids had a statistically significantly higher risk of subsequent oral opioid prescription (P < 0.0001), opioid abuse (P = 0.0005), substance abuse (P < 0.0001), overdose by opioids (P = 0.031), constipation (P < 0.0001), and chronic pain (P < 0.0001) 3 months to 5 years after surgery.

Conclusions: This study finds female, African American, and Latino populations have a higher risk of being prescribed opioids postoperatively. This prescription may confer risks of potentially serious complications related to opioid use. Dermatologic surgeons should be aware of the risks these populations face when determining candidacy for postsurgical opioid analgesia.