Perioperative management and the associated rate of adverse events in dermatological procedures performed by dermatologists in New Zealand

Abstract

Dermatological surgery performed in an outpatient setting is common and generally perceived as safe, but the potential for serious adverse events does exist. Furthermore, there is a current lack of guidelines regarding preoperative and intraoperative monitoring of such patients. This is a retrospective study that involved a written questionnaire sent to current practising New Zealand dermatologists. Aspects investigated include their practice relating to preoperative assessments and intraoperative monitoring during standard dermatological procedures, and the resulting rate of adverse events. We found that most respondents performed dermatological procedures in dedicated theatres in outpatient clinics. The majority of survey respondents would screen for and optimize risk factors prior to surgery. Most respondents would not record vital sign measurements either preoperatively or intraoperatively. Antibiotic prophylaxis was generally only prescribed if clinically indicated, and anticoagulation and antiplatelet therapies were in the majority of cases never withheld prior to surgery. Infection (<3.5%) and bleeding (<2%) were the most common postoperative complications, with other serious adverse events being extremely rare. Although dermatological surgery continues to be safely performed in the outpatient setting, attempts should still be made to identify patients who are at higher risk for surgery and extra precautions should be applied to these selected patients.

An Update on Antibiotic Prophylaxis in Dermatologic Surgery

“…Two large prospective studies taking place in subtropical Australia found much higher infection rates for simple dermatologic surgery than would normally be expected (8.7% in 972 patients [13], 8.6% in 857 patients [25]). The reasons for this are unclear but we postulate that high ambient temperature and humidity may improve conditions for bacterial colonization.…”

“…In a retrospective review of 8850 elective hand surgery cases, the infection rate was only 0.35% yet 31% received AP [10]. Other recent studies, however, have shown judicious AP use [22,25].…”

Heightened Infection-Control Practices are Associated with Significantly Lower Infection Rates in Office-Based Mohs Surgery

“…Most infections are attributed to Staphylococcus aureus , which contaminates the wound bed at the time of surgery from the exogenous environment or the patient's skin flora 1,2 . The reported rate of infection in MMS patients is generally lower than these figures, ranging from 0.07% to 3.5% 3–8 …”

Disinfection, sterilization and operation theater guidelines for dermatosurgical practitioners in India

“…[1][2][3] Superficial suppuration constitutes the commonest form of infections encountered, systemic infective complications being rare. [2] Postoperative skin infections occur essentially as a result of noncompliance or breach in the standard infection control practices and lead to morbidity, disfigurement and dissatisfaction amongst patients undergoing dermatological surgery. Since many of the procedures are cosmetic procedures, such incidents may also lead to medicolegal consequences.…”