A Four-Year Retrospective Assessment of Post-Operative Complications in Immunosuppressed Patients Following Mohs Micrographic Surgery

Publication date: Available online 28 November 2018

Source: Journal of the American Academy of Dermatology

Author(s): Pallavi Basu, Alina Goldenberg, Natasha Cowan, Robert Eilers, Jennifer Hau, Shang I. Brian Jiang

Abstract

Background

Many patients undergoing Mohs micrographic surgery for basal and squamous cell carcinomas are immunocompromised, yet post-operative complications associated with different types of immunosuppression are largely unstudied.

Objective

To determine the incidence and nature of post-operative complications in immunosuppressed patients undergoing Mohs surgery.

Methods

A retrospective cross-sectional chart review of patient characteristics, clinical characteristics, and complications.

Results

Compared to immunocompetent cases, univariable analysis showed immunosuppression was associated with 9.6 times the odds of post-operative complication (p=0.003). Solid organ transplant recipients had 8.824 higher odds (p=0.006) and immunosuppressive therapy use displayed 5.775 higher odds (p=0.021). Surgical site infection (2.5%) and dehiscence (0.51%) were more prevalent among immunosuppressed patients, with an overall complication rate of 5.4% in this population. Multivariable analysis of the association between immunosuppression and post-operative complication closely trended toward, but did not meet, significance (p=0.056).

Limitations

This was a single-center, retrospective study. Other limitations include lack of non-solid organ transplants, limited medication data on non-transplant patients, and exclusion of cases with double transplants or multiple sources of immunosuppression.

Conclusions

Immunosuppression overall, particularly solid organ transplant and immunosuppressive therapy use, places patients at higher risk for post-operative complications including surgical site infection and wound dehiscence following MMS.

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