Telephone follow‐up for monitoring of complications and boosting patient satisfaction after inpatient dermatosurgery: a prospective two‐center study

SummaryBackground and ObjectivesDue to frailty, dermatosurgery in the elderly is preferably performed under tumescent local anesthesia, but data is limited. The aim was to evaluate tumescent local anesthesia for skin cancer surgery in the elderly with focus on clinical benefits (treatment processes, pain management) and local postoperative complication risk.Patients and MethodsInvestigation of patients ≥ 75 years with inpatient head and neck skin cancer surgery under tumescent local anesthesia.Results2,940 procedures in 782 patients (mean age 83.3 years) were performed with the aim of complete tumor resection during the inpatient stay. 3.8 (range: 1–20) interventions were done over an average of 4.9 days (range: 1–28). 43.2% did not require any postoperative analgesia. 53.5% received NSAIDs, 3.3% opioids. Infection (13.6%) was the most common local postoperative complication. Surgical intervention due to bleeding was required in 2.8%. None was hemoglobin relevant or life‐threatening. Suture dehiscence and necrosis were rare (0.6%).ConclusionsTumescent local anesthesia is an effective method for skin cancer surgery in the elderly. By avoiding general anesthesia, treatment processes can be optimized and anesthesiologic risks minimized. Local postoperative complications are still low and well treatable. The long‐lasting analgesia results in a reduced need for analgesics and drug interactions.

Section: Discussionmentioning

confidence: 40%

“…11.2% (31/277) and 5.8% (16/277) required pain medication at the time of the first and second call, respectively. 43 In our study, 43.2% did not require any postoperative analgesia and only 3.3% needed opioids. On the day of surgery, the patients reported VAS of 2.4, compared to VAS of 0.8 at discharge.…”

Section: Advantages For Pain Managementmentioning

confidence: 42%

Tumescent local anesthesia in geriatric patients with head and neck skin cancer – a retrospective study of 782 patients

Schnabl,

Garbe,

Breuninger

et al. 2024

“…In some cases, postsurgical complications, such as wound healing impairment, secondary bleeding on anticoagulation, or recurrence after previous marginal excision, also resulted in allegations of medical malpractice. Some of the allegations of medical malpractice might have been prevented by optimal hygiene during the interventions or by improved postsurgical monitoring of complications, for example by means of telephone follow-ups [22,23].…”

Section: Discussionmentioning

confidence: 99%

Medical error analysis in dermatology according to the reports of the North Rhine Medical Association from 2004 to 2018

Lehmann

Appelbaum

Ostermann

et al. 2022

Summary Background Assessment of complaints addressed to the Expert Committee for Medical Malpractice Claims of the North Rhine Medical Association helps to identify quality assurance problems in dermatology. Methods 333 dermatological reports (years 2004–2018) were allocated to three five‐year intervals in order to show changes of total number of reports and with regard to indications, types of care, defined diagnosis categories, and therapeutic interventions. Statistical analysis was mainly descriptive (SPSS 27). Representative cases are explained in more detail. Results The number of dermatological reports fell from 119 in the first to 92 reports in the last five‐year interval, along with a decline in treatment error rates (43 % and 29 %) despite an increasing number of procedures across disciplines. 104 reports dealt with (supposed) diagnostic errors, 156 with physical or pharmacological therapies, and 73 reports with surgery. The latter had a low treatment error rate (29 %). Conclusions In comparison to the number of dermatological treatments in Germany, patient allegations are raised only rarely indicating greater patient satisfaction and/or a lower risk potential in dermatology. Incorrect dosages or device settings, diagnostic errors, and deficits in obtaining informed consent are relevant sources of error as underlined by the presented case reports.

“…Es gab keine Angaben über die verwendete Anästhesiemethode. Zum Zeitpunkt des ersten beziehungsweise zweiten Anrufs benötigten 11,2% (31/277) beziehungsweise 5,8% (16/277) Schmerzmittel 43 . In unserer Studie benötigten 43,2% keine postoperative Analgesie und nur 3,3% Opioide.…”

Section: Diskussionunclassified

Tumeszenz‐Lokalanästhesie bei geriatrischen Patienten mit Hauttumoren im Kopf‐Hals‐Bereich – Eine retrospektive Studie an 782 Patienten

Schnabl,

Garbe,

Breuninger

et al. 2024

ZusammenfassungHintergrund und ZielsetzungAufgrund ihrer Morbidität werden dermatochirurgische Eingriffe bei älteren Patienten vorzugsweise in Tumeszenz‐Lokalanästhesie durchgeführt. Allerdings ist die Datenlage hierzu begrenzt. Ziel der Arbeit war es, die Tumeszenz‐Lokalanästhesie für Hautkrebsoperationen bei älteren Patienten mit dem Fokus auf klinische Vorteile (Behandlungsprozesse, Schmerzmanagement) und dem lokalen postoperativen Komplikationsrisiko zu evaluieren.Patienten und MethodikUntersuchung von Patienten ≥75 Jahren mit stationär durchgeführten Hautkrebsoperationen im Kopf‐Hals‐Bereich unter Tumeszenz‐Lokalanästhesie.Ergebnisse2940 Eingriffe bei 782 Patienten (Durchschnittsalter 83,3 Jahre) mit dem Ziel einer vollständigen Tumorresektion während des stationären Aufenthaltes wurden durchgeführt. 3,8 (Bereich: 1–20) Eingriffe erfolgten über einen Zeitraum von durchschnittlich 4,9 Tagen (Bereich: 1–28). 43,2% benötigten keine postoperative Analgesie. 53,5% erhielten NSAID, 3,3% Opioide. Wundinfektionen (13,6%) waren die häufigste lokale postoperative Komplikation. Chirurgische Interventionen aufgrund von Nachblutungen waren in 2,8% der Fälle erforderlich. Keine der Blutungen waren hämoglobinrelevant oder lebensbedrohlich. Nahtdehiszenzen und Nekrosen waren selten (0,6%).SchlussfolgerungenDie Tumeszenz‐Lokalanästhesie ist für Hautkrebsoperationen bei älteren Menschen eine effektive Anästhesiemethode. Durch den Verzicht auf eine Vollnarkose können die Behandlungsabläufe optimiert und anästhesiologische Risiken minimiert werden. Lokale postoperative Komplikationen treten eher selten auf und sind gut behandelbar. Die langanhaltende Analgesie führt zu einem geringeren Analgetikabedarf und selteneren Medikamenteninteraktionen.