A 4-year retrospective assessment of postoperative complications in immunosuppressed patients following Mohs micrographic surgery

Basu, Pallavi; Goldenberg, Alina; Cowan, Natasha; Eilers, Robert; Hau, Jennifer; Jiang, Shang I Brian

doi:10.1016/j.jaad.2018.11.032

Cited by 27 publications

(39 citation statements)

References 25 publications

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“…Data on SSI in immunocompromised patients is highly heterogeneous. A recent study performed on patients undergoing Mohs surgery suggested that there are increased SSI rates in patients with solid organ transplants [22], but other studies have reported no statistically significant influence of immunosuppressive medication on SSI levels [4,7,15]. Consistent with the latter studies, we did not observe a higher incidence of SSI in immunocompromised patients.…”

Section: Discussionsupporting

confidence: 90%

Postoperative complications in dermatological patients undergoing microscopically controlled surgery in inpatient setting (next‐day surgery): A single‐center epidemiological study

Artamonova

Schmitt

Yazdi

et al. 2020

J Deutsche Derma Gesell

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Background: Surgical site infections (SSI), bleeding, and necrosis are possible complications of dermatological surgery, and their rates are well described for Mohs surgery (same-day surgery). However, there are only limited data on their occurrence in microscopically controlled surgery of the form in which it is practiced in German hospitals (next-day surgery). Materials and Methods: We performed a retrospective analysis of patient records of patients hospitalized for microscopically controlled surgery during the year 2017 (12 months) in the Department of Dermatology and Allergology at the University Hospital of the RWTH Aachen (Aachen, Germany). The investigation addressed postoperative outcomes. Results: 319 patients underwent 528 dermatosurgical procedures in the defined period. Bleeding and necrosis occurred in 3.8 % (20/528) and 1.7 % (9/528) of the procedures, respectively. SSI occurred in 5.1 % (27/528) of the cases. The occurrence of bleeding was a statistically significant risk factor for SSI (p = 0.01). Furthermore, bleeding, SSI, and wound closure with a full-thickness graft were statistically significant risk factors for the development of necrosis (p < 0.05). Diabetes or immunosuppression were not found to be statistically significant risk factors for the development of SSI or necrosis after dermatologic surgery (p > 0.05). Conclusions: Complication rates in microscopically controlled surgery (next-day surgery) are generally low and similar to those reported for Mohs surgery (same-day surgery). Therefore, it appears that some evidence-based perioperative recommendations that have been developed for Mohs surgery could be applied to German inpatient dermatosurgery. However, prospective studies with larger patient numbers are required to offer concrete recommendations specifically for microscopically controlled surgery (next-day surgery).

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Section: Discussionsupporting

confidence: 90%

Postoperative complications in dermatological patients undergoing microscopically controlled surgery in inpatient setting (next‐day surgery): A single‐center epidemiological study

Artamonova

Schmitt

Yazdi

et al. 2020

J Deutsche Derma Gesell

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“…The reported rates of SSI after MMS in the dermatologic literature range from 0.7% to 3.4%, even in the absence of postoperative antibiotics 9,12,13,19 . Although infections are higher in immunosuppressed patients, a recent large review still only demonstrated a postoperative SSI rate of 2.5% in their immunosuppressed patients 20 . We performed this study to evaluate our hypothesis that postoperative antibiotics are not associated with a decreased risk of infection.…”

Section: Discussionmentioning

confidence: 96%

Do Postoperative Antibiotics Affect Outcomes in Mohs Reconstructive Surgery?

et al. 2020

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Objectives/Hypothesis The prescribing of postoperative antibiotics for patients undergoing Mohs reconstructive surgery has increased in the last decade, while antibiotic resistance has been increasing. We hypothesized that routine prescribing of postoperative antibiotics after Mohs reconstruction does not decrease the risk of surgical site infection. Study Design Retrospective, single‐institution cohort study. Methods This study assessed patients who underwent Mohs reconstructive surgery from January 1, 2012, to January 29, 2019. The main outcomes assessed included postoperative surgical site infections, partial or full flap/graft necrosis, hematoma, and dehiscence. Results A total of 900 defects in 800 patients (mean age [range] = 65.3 [21–96], 54.60% female) were identified over the 7‐year period. Patient‐specific variables reviewed included comorbidities, age, and smoking status. Surgery‐specific variables analyzed included defect characteristics, time interval between Mohs micrographic surgery and reconstruction, reconstructive modalities, and use of postoperative antibiotics. All patients received peri‐incisional antibiotics. On regression analysis, use of cartilage grafts (odds ratio [OR]: 6.53; 95% CI: 2.1‐20.6; P = .001), current smoking status (OR: 6.67; 95% CI: 2.09‐21.30; P = .001), full‐thickness defects (OR: 1.2; 95% CI: 1.0‐3.4; P = .045), and interpolated flap reconstruction (OR: 3.4; 95% CI: 1.0‐11.5; P = .049) were associated with an increased risk of postoperative infections. Smoking and cartilage grafting remained significant on bivariable regression modeling. Use of perioperative antibiotics was not associated with a decreased risk of infection (OR: 1.82; 95% CI: 0.23‐14.21; P = .568). Conclusions We found no association between postoperative infections after Mohs reconstructive surgery and the use of postoperative antibiotics. These data support a more targeted approach to antibiotic prescribing in Mohs reconstructive surgery. Level of Evidence 4 Laryngoscope, 131:E434–E439, 2021

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“…Analyses of special populations including immunosuppressed, elderly, children, and adolescent groups and their associated dermatologic surgical complications have also been performed. Basu et al 17 conducted a single‐center retrospective cross‐sectional chart review of MMS complication rates in immunosuppressed patients over a 4‐year period. They found that when compared with immunocompetence, immunosuppression had 9.6 times the odds of postoperative complications ( P = .003), and specifically solid organ transplant recipients had 8.824 times higher odds ( P = .06).…”

Section: Complications Associated With Cutaneous Surgerymentioning

confidence: 99%

Complications of cutaneous surgery

Rothstein

Cohen²

2020

Dermatological Reviews

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Background Cutaneous surgery is associated with multiple complications including hemorrhage, surgical site infection, necrosis, and scarring. As demand for dermatologic surgery rises, it is imperative that dermatologists have a comprehensive understanding of the potential surgical risks to enhance patient safety and outcomes. Aims The purpose of this review is to highlight the rates, prevention, and management of common complications associated with cutaneous surgery, with a focus on scalpel‐based surgeries including Mohs micrographic surgery and standard surgical excision. Material and Methods Articles from PubMed are highlighted and our clinical experience is presented. Results Cutaneous surgery is overall safe and associated with low rates of complications that are predominantly minor and not life‐threatening. Prevention and management strategies vary according to the specific complication being addressed. Discussion Dermatologists should be familiar with the complications of cutaneous surgery. As our knowledge of surgical complications expands, the outcomes of our patients will continue to improve.

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A 4-year retrospective assessment of postoperative complications in immunosuppressed patients following Mohs micrographic surgery

Cited by 27 publications

References 25 publications

Postoperative complications in dermatological patients undergoing microscopically controlled surgery in inpatient setting (next‐day surgery): A single‐center epidemiological study

Postoperative complications in dermatological patients undergoing microscopically controlled surgery in inpatient setting (next‐day surgery): A single‐center epidemiological study

Do Postoperative Antibiotics Affect Outcomes in Mohs Reconstructive Surgery?

Complications of cutaneous surgery

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