Risk assessment in surgical patients: balancing iatrogenic risks and benefits

Cutaneous procedures are associated with a wide variety of potential risks. This contribution discusses risk-related considerations in the preoperative, intraoperative, and postoperative management of dermatologic surgery patients. In the preoperative setting, major considerations include bleeding risks, the presence of pacemakers or defibrillators, risks of local and systemic infection, and the possibility of adverse reactions to local anesthetics and topical agents used for dermatologic procedures. Risk is minimized intraoperatively through careful attention to sterile technique, maintaining adequate hemostasis, skillful management of emerging complications, and effective closure of surgical defects. To optimize outcomes, postoperative priorities include effective management of postoperative bleeding, appropriate wound care, and prevention and treatment of hypertrophic scars and keloids. Reducing the likelihood of adverse surgical outcomes requires identification of potential risk factors and case-specific approaches to minimize risks while simultaneously preparing for the possibility of complications.