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

Oral and maxillofacial surgeons prescribe antibiotics for a spectrum of procedures and clinical indications. However, it is unclear whether surgeon experience is related to antibiotic prescribing patterns.

The purpose of this study was to evaluate the association between surgeon experience, measured by years in practice (YIP), and antibiotic prescribing by oral and maxillofacial surgeons treating Medicare beneficiaries.

This was a retrospective cohort study using the 2022 Medicare Part D prescribers dataset. Surgeons were included if they had a specialty description of oral and maxillofacial surgery and antibiotic prescription data.

The primary predictor was YIP, calculated using the National Provider Identifier enumeration dates. This variable was categorized as 0-3, 4-8, 9-13, and ≥14 years.

The primary outcome variable was antibiotic claims per beneficiary. Secondary outcomes included total antibiotic claims and antibiotic prescribing rate, defined as the proportion of prescriptions that were antibiotics.

Covariates included surgeon sex and region, number of Medicare beneficiaries, and demographic and medical characteristics of beneficiaries.

Descriptive statistics, bivariate analyses, and multiple linear regression were used to determine the relationship between YIP and outcome variables. Beta (β) coefficients were calculated from the regression models. Higher-volume antibiotic prescribers were defined as the top 10% of prescribers based on total antibiotic claims.

This study included 6,403 surgeons with a total of 928,365 antibiotic claims to Medicare beneficiaries in 2022. There were 4,351 (68.0%) 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 overall cohort was 1.0 ± 0.3. Compared to surgeons with 0-3 YIP, those with 9-13 YIP (b = 0.08; 95% CI: 0.02-0.14; P = .011) and ≥14 YIP (b = 0.14; 95% CI: 0.08-0.20; P < .001) had higher antibiotic claims per beneficiary, and these differences were statistically significant. In all YIP categories, the top 10% of prescribers were associated with 28.1-32.2% of all antibiotic claims.

Oral and maxillofacial surgeons with more YIP generally prescribe more antibiotics. Additional studies are necessary to inform antibiotic stewardship interventions to ultimately reduce antibiotic prescription volume.