1. Complications Associated with Mohs Micrographic Surgery: Data from the Nationwide Prospective Cohort REGESMOHS
- Author
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Pedro Sánchez-Sambucety, Yolanda Delgado-Jiménez, Antonio Martorell, Juan L Artola-Igarza, R. Miñano-Medrano, Pablo De la Cueva-Dobao, A. Alfaro-Rubio, Irati Allende-Markixana, Rafael Botella-Estrada, Angeles Flórez-Menéndez, Veronica Ruiz-Salas, Ricardo Suárez-Fernández, Begoña Escutia-Muñoz, J.R. Garcés, Laura Sainz-Gaspar, Victoriano Morales-Gordillo, Matías Mayor-Arenal, O. Sanmartín-Jiménez, Lucia Carnero-González, Ignacio García-Doval, Hugo Vázquez-Veiga, Beatriz García Bracamonte, Pedro Redondo, B. González-Sixto, Eva Vilarrasa, José Luis Estebaranz, Miguel Ángel Descalzo, Julia M Sánchez-Schmidt, Cristina Ciudad, A. Toll-Abelló, and Regesmohs
- Subjects
medicine.medical_specialty ,Skin Neoplasms ,medicine.drug_class ,Mohs surgery ,Surgical wound infection ,medicine.medical_treatment ,Dermatology ,Surgical Flaps ,Cohort Studies ,Non-melanoma skin cancer ,Postoperative complications ,medicine ,Humans ,Skin cancer ,General anaesthesia ,Prospective Studies ,Intraoperative complications ,Adverse effect ,Prospective cohort study ,Retrospective Studies ,Surgery in dermatological practice ,business.industry ,Incidence (epidemiology) ,Blood loss, Intraoperative complications, Mohs surgery, Non-melanoma skin cancer, Postoperative complications, Skin cancer, Surgery in dermatological practice, Surgical wound infection ,Anticoagulant ,Blood loss ,Perioperative ,Mohs Surgery ,medicine.disease ,Surgery ,business - Abstract
Background: Large prospective studies on the safety of Mohs micrographic (MMS) surgery are scarce, and most focus on a single type of surgical adverse event. Mid-term scar alterations and functional loss have not been described. Objectives: To describe the risk of MMS complications and the risk factors for them. Methods: A nationwide prospective cohort collected all adverse events on consecutive patients in 22 specialised centres. We used multilevel mixed-effects logistic regression to find out factors associated with adverse events. Results: 5,017 patients were included, with 14,421 patient-years of follow-up. 7.0% had some perioperative morbidity and 6.5% had mid-term and scar-related complications. The overall risk of complications was mainly associated with use of antiaggregant/anticoagulant and larger tumours, affecting deeper structures, not reaching a tumour-free border, and requiring complex repair. Age and outpatient setting were not linked to the incidence of adverse events. Risk factors for haemorrhage (0.9%) were therapy with antiaggregant/anticoagulants, tumour size, duration of surgery, and unfinished surgery. Wound necrosis (1.9%) and dehiscence (1.0%) were associated with larger defects and complex closures. Immunosuppression was only associated with an increased risk of necrosis. Surgeries reaching deeper structures, larger tumours and previous surgical treatments were associated with wound infection (0.9%). Aesthetic scar alterations (5.4%) were more common in younger patients, with larger tumours, in H-area, and in flap and complex closures. Risk factors for functional scar alterations (1.7%) were the need for general anaesthesia, larger tumours that had received previous surgery, and flaps or complex closures. Conclusions: MMS shows a low risk of complications. Most of the risk factors for complications were related to tumour size and depth, and the resulting need for complex surgery. Antiaggregant/anticoagulant intake was associated with a small increase in the risk of haemorrhage, that probably does not justify withdrawal. Age and outpatient setting were not linked to the risk of adverse events.
- Published
- 2021
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