Risk Factors for Surgical Site Infection After Minor Dermatologic Surgery Advances in skin & wound care

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• The authors of this meta-analysis combined data collected from 4 randomized controlled trials conducted in North Queensland, Australia, to ultimately include 3819 patients who underwent surgical excisions by their general practitioners over a 10-year period. Of these patients, 298 (7.8%) developed a surgical site infection (SSI). The authors found a significant risk associated with age (RR, 1.01; P = .008), with patients with SSIs being an average of 6 years older than those without SSIs (P = .004). Other risk factors were excisions from the upper limbs (RR, 3.03; P = .007), excisions from the lower limbs (RR, 3.99; P = .009), and flap/two-layer procedures (RR, 3.23).

• Further elucidation of these findings, especially for the independent risk factor for age, is needed. These risk factors could someday be incorporated into evidence–based guidelines for antibiotic prophylaxis for minor dermatologic surgery.

– Alex Noble, MD

Written by

 

 

Ashish C. Bhatia MD, FAAD

This study by our colleagues in Australia evaluated risk factors for surgical site infections (SSIs) after clean surgical excisions by primary care physicians in the outpatient setting. It was a secondary data analysis from four previous randomized controlled trials.

Only lesions removed by surgical excision were aggregated for inclusion. Excluded from the study were patients taking oral antibiotics or those who required antibiotic prophylaxis or who were on immunosuppressants. Repeat patients as well as patients with any sites beyond the first excision were excluded as well. SSIs were defined as local skin and soft tissue infections within 30 days of the procedure.

Infections occurred in 7.8% (298) of the 3819 excisions. Patients with infections were on average 6 years older than those without infections. The only diagnosis associated with a higher infection rate was skin cancer. Those who took medications of any kind had a statistically higher rate of SSI, although not with any specific medication. Current or ex-smokers had an increased incidence of SSI as well, but this was not statistically significant.

As far as location, the incidence of SSI was higher on the upper limbs (3.03 times) and lower limbs (3.99 times) compared with head and neck lesions. As far as lesion type, squamous cell carcinoma (12.8%), melanocytic lesions (8.5%), and basal cell carcinomas (8.4%) were those with the highest risk of SSI. Complex procedures (such as flaps or two-layer procedures) had a nearly three times higher risk of infection compared with elliptical excisions.

These findings are similar to those found in other such studies. Overall, outpatient surgical excisions have a low rate of SSIs. Being aware of these risk factors for SSIs can help those performing excisions have a higher index of suspicion for SSIs and even help them choose when to prophylactically prescribe topical or oral antibiotics.

Abstract

BACKGROUND

Surgical site infection (SSI) after dermatologic surgery is associated with poor outcomes including increased recovery time, poor cosmesis, and repeat visits to doctors. Prophylactic antibiotics are prescribed to reduce these adverse outcomes. Identifying risk factors for SSI will facilitate judicious antibiotic prophylaxis.

OBJECTIVE

To identify risk factors for SSI after minor dermatologic surgery.

METHODS

Individual patient data from four large randomized controlled trials were combined to increase statistical power. A total of 3,819 adult patients requiring minor skin procedures at a single facility were recruited over a 10-year period. The main outcome measure was SSI.

MAIN RESULTS

A total of 298 infections occurred, resulting in an overall incidence of 7.8% (95% confidence interval [CI], 5.8–9.6), although the incidence varied across the four studies (P = .042). Significant risk factors identified were age (relative risk [RR], 1.01; 95% CI, 1.001–1.020; P = .008), excisions from the upper limbs (RR, 3.03; 95% CI, 1.76–5.22; P = .007) or lower limbs (RR, 3.99; 95% CI, 1.93–8.23; P = .009), and flap/two-layer procedures (RR, 3.23; 95% CI, 1.79–5.85; P = .008). Histology of the excised lesion was not a significant independent risk factor for infection.

CONCLUSIONS

This study demonstrated that patients who were older, underwent complex excisions, or had excisions on an extremity were at higher risk of developing an SSI. An awareness of such risk factors will guide evidence-based and targeted antibiotic prophylaxis.

Advances in skin & wound care

Risk Factors for Surgical Site Infection After Minor Dermatologic Surgery

Adv Skin Wound Care 2021 Jan 01;34(1)43-48, M Delpachitra, C Heal, J Banks, D Charles, S Sriharan, P Buttner 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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