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Risk Factors for Surgical Site Infection after Minor Dermatologic Surgery
Meth Delpachitra1, Clare Heal, Jennifer Banks
1Meth Delpachitra, MBBS, is Registrar, Royal Brisbane and Women's Hospital, Queensland, Australia. Clare Heal, PhD, MBChB, is Promotional Chair, Discipline of General Practice and Rural Medicine, and Jennifer Banks, PhD, MBS, is Senior Research Officer, James Cook University, Mackay. Daniel Charles, MBBS, is Registrar, Cairns Hospital. Shampavi Sriharan, MBBS, is Associate Lecturer, University of Queensland, Brisbane. Petra Buttner, PhD, is Adjunct Professor, Epidemiology & Biostatistics, Centre for Chronic Disease Prevention, James Cook University, Townsville. The authors have disclosed no financial relationships related to this article. Submitted December 19, 2019; accepted in revised form February 14, 2020.
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.
Insights
Older age, complex excisions, and procedures on extremities increase the risk of surgical site infections (SSI) after dermatologic surgery. Identifying these factors aids targeted antibiotic prophylaxis.
Area of Science:
- Dermatologic Surgery
- Infectious Disease Epidemiology
Background:
- Surgical site infections (SSI) following dermatologic surgery lead to adverse outcomes like prolonged recovery and poor cosmesis.
- Prophylactic antibiotics are commonly used to mitigate these risks.
- Identifying specific risk factors for SSI is crucial for optimizing antibiotic prophylaxis strategies.
Purpose of the Study:
- To determine the key risk factors associated with developing surgical site infections (SSI) after minor dermatologic surgical procedures.
Main Methods:
- Pooled individual patient data from four large randomized controlled trials.
- Analysis included 3,819 adult patients undergoing minor skin procedures over a decade.
- Surgical site infection (SSI) served as the primary outcome measure.
Main Results:
- An overall SSI incidence of 7.8% was observed across the studies.
- Significant risk factors for SSI included advanced age (RR 1.01), excisions on upper limbs (RR 3.03), lower limbs (RR 3.99), and flap/two-layer procedures (RR 3.23).
- Histology of the excised lesion was not found to be an independent risk factor for infection.
Conclusions:
- Patients who are older, undergo complex excisions, or have procedures on extremities face a higher risk of SSI.
- Understanding these risk factors enables the development of evidence-based, targeted antibiotic prophylaxis protocols.
- This research supports more judicious use of prophylactic antibiotics in dermatologic surgery.
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