Postoperative surgical site infection rate in patients with diabetes following Mohs micrographic surgery: a retrospective analysis

Abstract

Background Incidence of surgical site infection (SSI) following Mohs micrographic surgery (MMS) amongst patients with diabetes is largely unknown. Objective Evaluate diabetes as a potential SSI risk factor in MMS by comparing SSI incidence in a cohort of patients with and without diabetes. Methods A 5‐year retrospective review to determine SSI rate in patients with diabetes compared to patients without diabetes. SSI incidence in patients with diabetes was further compared by A1c, and the impact of antibiotics on SSI rate was also examined. Results Overall rate of SSI was 1.47% (53/3597 cases). SSI rate amongst patients with diabetes was 1.95% (14/719 cases) compared to 1.35% (39/2878 cases) in patients without diabetes, with a non‐significant odds ratio for SSI of 1.45 (95% CI = 0.78–2.68, P = 0.241). Multivariable logistic regression analysis revealed no difference in SSI. Stratification of diabetic patients by A1c into ≥7.0 and <7.0 compared to patients without diabetes yielded no statistically significant difference in SSI amongst all groups (P = 0.815). Whether an antibiotic was prescribed did not significantly impact SSI rate between groups. Conclusion No significant difference in postoperative SSI was found in patients with diabetes compared to patients without diabetes following MMS regardless of degree of glycaemic control.

Perioperative antibiotic prophylaxis in skin surgery – Position paper of the Antibiotic Stewardship working group of the German Society for Dermatologic Surgery (DGDC), Part 1: Procedure‐ and patient‐related risk factors

“…In a prospective study, patients with diabetes did not show statistically significantly higher infection rates after Mohs surgery compared with the general population 8 . In a retrospective study of 1977 Mohs surgery procedures diabetes also did not have a statistically significant influence on SSI rates, 21 which was confirmed in a recent retrospective analysis of 3597 cases 40 . There are only a few studies on microscopically controlled surgery, which is established in Germany, and these likewise confirm the absence of an association between diabetes and SSIs 11,34 .…”

“…8 In a retrospective study of 1977 Mohs surgery procedures diabetes also did not have a statistically significant influence on SSI rates, 21 which was confirmed in a recent retrospective analysis of 3597 cases. 40 There are only a few studies on microscopically controlled surgery, which is established in Germany, and these likewise confirm the absence of an association between diabetes and SSIs. 11,34 It is noteworthy that diabetes has not been proven to be a significant factor for the occurrence of SSI even in dermatologic surgery at specific localization (ear) and in immunosuppressed patients.…”

Impact of type 2 diabetes on surgical site infections and prognosis post orthopaedic surgery: A systematic review and meta‐analysis

“…Moreover, microvascular complications inherent in diabetes can impede blood flow to the surgical site, which could result in inadequate delivery of antibiotics and immune cells, further exacerbating the risk of SSIs. Lastly, diabetic patients often have other comorbidities like obesity and cardiovascular diseases, which can independently increase the risk of SSIs, thereby potentiating a vicious cycle of complications 27,28 …”

Perioperative Antibiotikaprophylaxe in der Dermatochirurgie – Positionspapier der Arbeitsgruppe Antibiotic Stewardship der Deutschen Gesellschaft für Dermatochirurgie (DGDC), Teil 1: Eingriffs‐ und patientenbezogene Risikofaktoren

“…In einer prospektiven Studie zeigten Patienten mit Diabetes mellitus nach Mohs‐Chirurgie keine statistisch signifikant höheren Infektionsraten verglichen mit der Allgemeinbevölkerung 8 . Auch in einer retrospektiven Untersuchung an 1977 Eingriffen in Mohs‐Chirurgie ergab sich kein statistisch signifikanter Einfluss des Diabetes mellitus auf die SSI‐Raten, 21 was in einer aktuellen retrospektiven Auswertung von 3597 Fällen bestätigt wurde 40 . Für die in Deutschland etablierte mikroskopisch kontrollierte Chirurgie liegen nur vereinzelte Studien vor, die den fehlenden Zusammenhang zwischen Diabetes mellitus und SSI ebenfalls bestätigen 11,34 .…”

“…8 Auch in einer retrospektiven Untersuchung an 1977 Eingriffen in Mohs-Chirurgie ergab sich kein statistisch signifikanter Einfluss des Diabetes mellitus auf die SSI-Raten, 21 was in einer aktuellen retrospektiven Auswertung von 3597 Fällen bestätigt wurde. 40 Für die in Deutschland etablierte mikroskopisch kontrollierte Chirurgie liegen nur vereinzelte Studien vor, die den fehlenden Zusammenhang zwischen Diabetes mellitus und SSI ebenfalls bestätigen. 11,34 Bemerkenswert ist, dass sich ein Diabetes mellitus auch bei dermatochirurgi-schen Eingriffen an Problemlokalisationen (Ohr) und bei immunsupprimierten Patienten nicht als signifikanter Faktor für das Auftreten einer SSI erwies.…”