Do rural oral and maxillofacial surgeons prescribe more postoperative opioids?

Abstract

Purpose: This study assesses rural-urban differences in opioid prescription practices among oral and maxillofacial surgeons (OMSs) who treated Medicare beneficiaries in 2017.

Methods: This cross-sectional study examines the 2017 Medicare Provider Utilization and Payment Dataset. The primary predictor variable was provider Rural-Urban Commuting Area code (rural versus urban). The primary outcome variable was mean opioid claims per Medicare beneficiary. Additional outcomes include total opioid claims volume, average Medicare beneficiaries and opioid cost per provider, mean days' supply of opioids per opioid claim, and average percentage of Medicare Part D claims represented by opioid claims. Mann-Whitney U tests compared continuous variables. A least-squares regression identified correlates of opioid claims volume.

Results: Rural OMSs demonstrated a higher mean opioid claims per OMS and opioid cost per provider compared to urban surgeons. Urban OMSs prescribed a greater mean days' supply of opioids per opioid claim. A larger percentage of Medicare Part D claims were represented by opioid claims for rural OMSs compared to urban OMSs. There were no differences in mean opioid claims per Medicare beneficiary. Male provider gender, female Medicare beneficiary gender, total number of beneficiaries, and a higher hierarchical condition category score were correlated with increased opioid claims per Medicare beneficiary for urban providers only.

Conclusion: Urban and rural OMSs prescribe a similar volume of opioids per Medicare beneficiary, with rural providers prescribing higher total volumes of opioids due to larger patient panels. This work indicates that rural and urban OMSs have similar opioid prescribing practices.