All authors are affiliated with the Department of Dermatology, University of Rochester Medical Center, Rochester, New York.
Dermatol Surg. 2022 Oct 1;48(10):1029-1032. doi: 10.1097/DSS.0000000000003562. Epub 2022 Sep 8.
Use of Mohs micrographic surgery (MMS) is highly prevalent, but little data are available on how surgeon experience affects surgical practice patterns.
To determine differences in use of MMS among surgeons of varying experience.
This cross-sectional study sampled from clinicians billing ≥200 mean annual Mohs surgery claims from the 2012 to 2018 Medicare Public Use File. The primary outcome was mean annual Mohs surgery claims for clinicians of varying experience. Secondary outcomes included use of flaps/grafts and prescribing of oral antibiotics, benzodiazepines, and opioids.
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]). Surgeons with 21 to 25 years of experience prescribed the most antibiotics (240.2 [216.5-263.8] mean annual claims), whereas those with >35 years of experience prescribed the longest courses (15.3 [14.2-16.4] days).
Midcareer surgeons performed the most mean annual Mohs surgery cases, whereas later career surgeons prescribed more frequent and longer courses of antibiotics suggesting changing practice patterns with additional years of experience.
Mohs 显微外科手术（MMS）的应用非常普遍，但关于外科医生经验如何影响手术实践模式的数据却很少。
确定不同经验水平的外科医生在 MMS 使用方面的差异。
本横断面研究从 2012 年至 2018 年 Medicare 公共使用文件中每年平均 Mohs 手术索赔超过 200 次的临床医生中抽取样本。主要结局是不同经验水平的临床医生每年平均 Mohs 手术索赔。次要结局包括皮瓣/移植物的使用以及口服抗生素、苯二氮䓬类药物和阿片类药物的开具情况。
在 1759 名独特的外科医生中，具有 16 至 20 年经验的外科医生每年进行的平均（95%置信区间）Mohs 手术病例最多（578.7 [556.7-600.6]）。具有 21 至 25 年经验的外科医生开具的抗生素最多（240.2 [216.5-263.8] 年平均索赔），而具有 >35 年经验的外科医生开具的抗生素疗程最长（15.3 [14.2-16.4] 天）。
中年外科医生进行的平均年度 Mohs 手术病例最多，而后期职业外科医生开具的抗生素更频繁且疗程更长，表明随着经验的增加，实践模式发生了变化。
