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Journal of the American Academy of Dermatology
Volume 80, n° 6
pages 1594-1601 (juin 2019)
Doi : 10.1016/j.jaad.2018.11.032
accepted : 20 November 2018
Original Articles

A 4-year retrospective assessment of postoperative complications in immunosuppressed patients following Mohs micrographic surgery
 

Pallavi Basu, BA a, Alina Goldenberg, MD, MAS b, Natasha Cowan, BS a, Robert Eilers, MD b, Jennifer Hau, MD b, Shang I Brian Jiang, MD b,
a School of Medicine, University of California San Diego, San Diego, California 
b Department of Dermatology, University of California San Diego, San Diego, California 

Correspondence to: Shang I Brian Jiang, MD, Department of Dermatology, University of California San Diego, 8899 University Center Lane, Suite 350, San Diego, CA 92122.Department of DermatologyUniversity of California San Diego8899 University Center Lane, Suite 350San DiegoCA92122
Abstract
Background

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

Objective

To determine the incidence and nature of postoperative complications in immunosuppressed patients undergoing Mohs micrographic surgery.

Methods

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

Results

Univariable analysis showed that compared with immunocompetence, immunosuppression was associated with 9.6 times the odds of postoperative complication (P  = .003), with solid organ transplant recipients having 8.824 times higher odds (P  = .006) and immunosuppressive therapy use displaying 5.775 times higher odds (P  = .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 the immunosuppressed population. Multivariable analysis of the association between immunosuppression and postoperative complication closely trended toward, but did not meet, significance (P  = .056).

Limitations

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

Conclusions

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

The full text of this article is available in PDF format.

Key words : dermatologic surgery, immunosuppression, Mohs micrographic surgery

Abbreviations used : BCC, MMS, NMSC, SCC, SOTR



 Funding sources: None.
 Conflicts of interest: None disclosed.
 Reprints not available from the authors.



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