Mohs y receta de Antibióticos
Variation in Prescribing and Factors Associated With the Use of Prophylactic Antibiotics for Mohs Surgery
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- Factors associated with increased postoperative antibiotic use in Mohs surgery included increasing number of surgical sites (OR, 1.24), number of Mohs stages (OR, 1.18), defect area (OR, 1.31), and the patient being female (OR, 1.14). Patient age older than 80 years was associated with decreased use of antibiotics (OR, 0.75), compared with age younger than 60 years. The odds of prescribing antibiotics differed significantly among surgeons; a 3.35-fold variation in postoperative antibiotic use was observed.
- There was a significant variation in antibiotic prescription among Mohs surgeons, even within a single institution. Prospective trials and consensus guideline development may be needed.
– InYoung Kim, MD
- Written by
Physicians make decisions and implement interventions because we believe that the patients we treat will benefit from the decisions and the interventions we make. However, our conclusions may be biased on anecdote and selective recollections. The authors of this study have examined the antibiotic-prescribing habits of four dermatologic surgeons within a single academic practice and have identified truly remarkable practice variation (10-fold with perioperative use!). Each of these surgeons involved almost certainly believes that his/her prescribing practices leaves the patient better off than with an alternative approach. However, because of the challenges associated with capturing outcomes from interventions, the question that remains unanswered is what within this spectrum of antibiotic-prescribing practices represents "best practice"?
We are poised to address this and similar questions on a scale which was previously not attainable. The AAD's national patient data registry, DataDerm, will potentially allow individual clinicians to review their own practices and for researchers to look at this question across literally thousands of practices and millions of patients. There is additional work to be done to figure out how to rigorously capture outcomes of treatment that will be required to define best practices. There is no question that this can and should be done. We owe this to our patients.
BACKGROUND
Antibiotic use associated with Mohs surgery is increasing.
OBJECTIVE
To understand variation in practice patterns and factors associated with antibiotic use.
MATERIALS AND METHODS
The authors conducted a retrospective cohort study of antibiotic use among patients treated with Mohs micrographic surgery between July 1, 2013, and June 30, 2017, at an academic medical center. Multivariate logistic regression was used to evaluate for associations between antibiotic prescribing and the surgeon, site, reconstruction, and patient characteristics.
RESULTS
The odds of prescribing antibiotics differed significantly between each surgeon evaluated; 3.35-fold variation in postoperative antibiotic use was observed. Increasing number of surgical sites (odds ratio [OR] 1.24; 95% confidence interval [CI] 1.09-1.41), number of Mohs stages required (OR 1.18; 95% CI 1.08-1.28), and defect area (OR 1.31; 95% CI 1.25-1.37), as well as patient female sex (OR 1.14; 95% CI 1.03-1.27), were associated with increased postoperative antibiotic use, whereas age >80 was associated with decreased use (OR 0.75; 95% CI 0.64-0.87) compared with age <60.
CONCLUSION
Antibiotics are more commonly prescribed for repairs that are considered higher risk for infection. However, significant variation exists between surgeons, even within a single institution, suggesting a need for prospective trials and consensus guideline development.
Variation in Prescribing and Factors Associated With the Use of Prophylactic Antibiotics for Mohs Surgery: A Single-Institution Retrospective Study
Dermatol Surg 2019 Oct 01;[EPub Ahead of Print], JS Barbieri, WC Fix, CJ Miller, JF Sobanko, TM Shin, N Howe, DJ Margolis, JR EtzkornSkin Care Physicians of Costa Rica
Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574
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posted by dermatica at
November 15, 2019
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