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Association of Postoperative Antibiotics With Surgical Site Infection in Mohs Micrographic Surgery
Ethan C Levin1, Conroy Chow2, Zaineb Makhzoumi3
1Department of Dermatology, University of California, San Francisco, California.
Background:
Surgical site infection (SSI) is the most frequent complication of Mohs micrographic surgery. Previous studies have identified risk factors for SSI, but it is not known whether antibiotic prophylaxis mitigates this risk.
Objective:
To measure the association between antibiotic prophylaxis and SSI in a convenience sample of Mohs cases and to report on the utility of propensity scoring to control for confounding by indication in registry data.
Methods:
Data were drawn from a pilot quality improvement registry of 816 Mohs cases. The relationship between antibiotic prophylaxis and SSI was assessed with logistic regression modeling using propensity score methods to adjust for confounding.
Results:
One hundred fifty-one cases were prescribed antibiotic prophylaxis (18.5%). Of 467 cases with follow-up, 16 (3.4%) developed SSI. Infection rates were higher in subjects prescribed prophylaxis, but propensity adjustment reduced this effect. Adjusted odds of infection were 1.47-fold higher in subjects prescribed antibiotics and not statistically significant (95% confidence interval 0.29-7.39; p = .64).
Conclusion:
Although there was no significant difference in SSI among patients prescribed prophylactic antibiotics, statistical precision was limited by the low incidence of infection. Larger population-based prospective registry studies including propensity adjustment are needed to confirm the benefit of prophylactic antibiotics in high-risk surgical cases.
Insights
Prophylactic antibiotics did not significantly reduce surgical site infections (SSI) in Mohs micrographic surgery cases. Further research is needed to confirm the benefit of antibiotic prophylaxis in high-risk patients.
Area of Science:
- Dermatology
- Surgical Oncology
- Infectious Disease
Background:
- Surgical site infection (SSI) is a common complication following Mohs micrographic surgery.
- Existing research has identified SSI risk factors but has not determined if antibiotic prophylaxis is effective.
- The role of prophylactic antibiotics in preventing SSIs after Mohs surgery remains unclear.
Purpose of the Study:
- To assess the association between antibiotic prophylaxis and SSI in Mohs surgery.
- To evaluate the effectiveness of propensity scoring in managing confounding by indication in registry data.
- To investigate the impact of prophylactic antibiotics on SSI rates in Mohs procedures.
Main Methods:
- Analysis of data from a pilot quality improvement registry of 816 Mohs cases.
- Logistic regression modeling was employed to examine the relationship between antibiotic prophylaxis and SSI.
- Propensity score methods were utilized to adjust for confounding factors.
Main Results:
- Antibiotic prophylaxis was prescribed in 18.5% of cases.
- Of 467 cases with follow-up, 16 (3.4%) developed SSI.
- While initial infection rates were higher with prophylaxis, propensity adjustment minimized this difference, yielding non-significant adjusted odds (OR=1.47, p=.64).
Conclusions:
- No statistically significant difference in SSI rates was observed between patients who received prophylactic antibiotics and those who did not.
- The study's statistical power was limited by the low incidence of SSIs.
- Larger, prospective, population-based registry studies with propensity adjustment are recommended to definitively ascertain the benefits of prophylactic antibiotics in high-risk Mohs surgery cases.
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