Prospective study of skin surgery in patients with and without known diabetes

To study the association between known diabetes and complications after skin surgery.

In a 5-year prospective observational study, 7,224 lesions were excised on 4,197 patients in a referral center involving one surgeon in a southern Australian locale.

One hundred ninety-six patients with known diabetes (4.7%) underwent 551 excision procedures (7.6%) 4,001 people without diabetes underwent 6,673 procedures. Patients with diabetes were older (72 +/- 13) than those without (64 +/- 17) (p<.001.) Infection incidence was significantly higher in patients with diabetes (4.2%, 23/551) than in those without (2.0%, 135/6,673) (p<.001). There were five bleeds in patients with diabetes (0.9%) versus 47 in those without (0.7%) (p=.58). The incidence of wound dehiscence in patients with diabetes (2) was not different from that in those without (22), (p=.90). Noninfective complications were 1.8% for patients both with diabetes (10/551) and those without (118/6,673). Two thousand three hundred seventy-one flaps resulted in 14 (0.6%) cases of end-flap necrosis, but no case occurred in patients with diabetes. Multivariate analysis using binary logistic regression demonstrated that known diabetes was predictive of infection (odds ratio=1.66, 95% confidence interval=1.05-2.65). Diabetes was not predictive of other complications.

Patients with known diabetes suffer more postoperative skin infections than those without. Noninfective complications are similar. Clinicians may consider antibiotic prophylaxis in their patients with diabetes facing high-risk skin surgery.