GP1d - Is Oral and Maxillofacial Surgeon Experience Associated With Antibiotic Prescribing to Medicare Beneficiaries?

Abstract: Background: Oral and maxillofacial surgeons prescribe antibiotics for a wide range of procedures, clinical indications, and traditional practices.^1,2 However, it remains unclear whether prescribing patterns vary according to surgeon experience. The objective of this study was to determine the association between surgeon experience and antibiotic prescribing by oral and maxillofacial surgeons.

Materials and Methods: This retrospective cohort study analyzed data from the 2022 Centers for Medicare and Medicaid Services (CMS) Medicare Part D Prescribers Dataset. Surgeons with a specialty description of oral and maxillofacial surgery and available antibiotic prescription data were included. Surgeon experience was measured by years in practice (YIP) and categorized as 0-3, 4-8, 9-13 and =14 years. The primary outcome was antibiotic claims per beneficiary, while secondary outcomes included total antibiotic claims and antibiotic prescribing rate, defined as the proportion of prescriptions that were antibiotics. Descriptive, bivariate, and multiple linear regression statistics were computed to evaluate the association between YIP and outcomes. Beta (β) coefficients were calculated from the regression models. Higher-volume prescribers were categorized as the top 10% of prescribers based on the total antibiotic prescription volume.

Results: This study included 6,403 oral and maxillofacial surgeons who had a total of 928,365 antibiotic claims to Medicare beneficiaries in 2022. There were 4,351 (68.0%) surgeons with =14 YIP, 1,163 (18.2%) with 9-13 YIP, 783 (12.2%) with 4-8 YIP, and 106 (1.7%) with 0-3 YIP. The mean antibiotic claims per beneficiary for the study cohort was 1.0 ± 0.3. The mean antibiotic claims per provider was 145.0 ± 126.3, and the mean antibiotic prescribing rate was 41.2%. Compared to surgeons with 0-3 YIP, those with 9-13 YIP (β: 0.08; 95% CI: 0.02 to 0.14) and =14 YIP (β: 0.14; 95% CI: 0.08 to 0.20) had significantly higher antibiotic claims per beneficiary compared to those with 0-3 YIP. Higher-volume prescribers were associated with 28.1% to 32.2% of all antibiotic claims depending on the YIP category. For the overall cohort, the mean antibiotic claims per beneficiary for higher-volume prescribers (top 10% based on total claims) was significantly greater than that for lower-volume prescribers (1.2 ± 0.2 vs 0.9 ± 0.3, P < .001). This pattern was consistent across all YIP categories.

Conclusions: Oral and maxillofacial surgeons later in their careers generally prescribe more antibiotics. Moreover, the top 10% of prescribers accounted for approximately 30% of all antibiotic claims regardless of surgeon experience. Further research is needed to inform antibiotic stewardship interventions to decrease antibiotic prescription volume.


References:

1. Milic T, Raidoo P, Gebauer D: Antibiotic prophylaxis in oral and maxillofacial surgery: a systematic review. Br J Oral Maxillofac Surg 59:633, 2021.

2. Deeb GR, Soung GY, Best AM, Laskin DM: Antibiotic prescribing habits of oral and Maxillofacial Surgeons in conjunction with routine dental implant placement. J Oral Maxillofac Surg 73:1926, 2015.