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Shared decision making for perioperative antibiotic use during Mohs micrographic surgery on the lower extremities

Lisa Fronek1, Michael J Davis2, Hubert T Greenway1

  • 1Department of Dermatology, Scripps Clinic Torrey Pines Bighorn Mohs Surgery and Dermatology, San Diego, California.

JAAD International
|July 15, 2024
PubMed
Abstract

Insights

Shared decision making (SDM) in Mohs micrographic surgery (MMS) reduced antibiotic prophylaxis (AP) prescriptions without increasing surgical site infections (SSI). Patients reported higher satisfaction with SDM, highlighting its value in dermatologic surgery.

Area of Science:

  • Dermatologic Surgery
  • Patient Decision Making
  • Infectious Disease Prevention

Background:

  • Mohs micrographic surgery (MMS) on lower extremities carries a higher risk of surgical site infection (SSI).
  • The use of antibiotic prophylaxis (AP) for MMS on lower extremities remains a topic of debate.
  • Optimizing AP strategies is crucial for patient outcomes and antimicrobial stewardship.

Purpose of the Study:

  • To evaluate the impact of shared decision making (SDM) on antibiotic prophylaxis (AP) usage during Mohs micrographic surgery (MMS) of the lower extremities.
  • To assess the influence of SDM on patient satisfaction and the incidence of surgical site infections (SSI).
  • To explore the novel application of SDM within dermatologic surgery.

Main Methods:

  • A prospective observational study comparing standardized SDM discussions with routine counseling for patients undergoing MMS on lower extremities.
  • Data collection included patient satisfaction using the SDMQ9 survey, SSI rates, and AP prescription rates.
  • A cohort of 51 patients was analyzed to compare outcomes between the SDM and control groups.

Main Results:

  • Antibiotic prophylaxis (AP) prescription rates were significantly lower in the SDM group (20%) compared to the control group (50%) (P = .025).
  • There was no significant difference in the incidence of surgical site infections (SSI) between the groups (8% in SDM vs. 7.7% in control; P = .668).
  • Patient satisfaction scores were substantially higher in the SDM group (4.73) compared to the control group (2.18) (P < .001).

Conclusions:

  • Shared decision making (SDM) effectively reduces antibiotic prophylaxis (AP) use in Mohs micrographic surgery (MMS) without compromising surgical site infection (SSI) rates.
  • SDM significantly enhances patient satisfaction in the context of MMS on lower extremities.
  • This study demonstrates the successful implementation of SDM in dermatologic surgery, offering a valuable approach for patient-centered care.
Keywords:
Mohs surgeryantibiotic prophylaxispostoperative skin infectionshared decision making

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