Document Detail

Adverse Events Associated With Mohs Micrographic Surgery: Multicenter Prospective Cohort Study of 20 821 Cases at 23 Centers.
MedLine Citation:
PMID:  24080866     Owner:  NLM     Status:  Publisher    
IMPORTANCE Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications of MMS are anecdotal or report findings from single centers or single events. OBJECTIVES To quantify adverse events associated with MMS and detect differences relevant to safety. DESIGN, SETTING, AND PARTICIPANTS Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. EXPOSURE Mohs micrographic surgery. MAIN OUTCOMES AND MEASURES Intraoperative and postoperative minor and serious adverse events. RESULTS Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. CONCLUSIONS AND RELEVANCE Mohs micrographic surgery is safe, with a very low rate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate. Common complications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely during MMS. We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changes would be cost-effective given the small risk reductions.
Murad Alam; Omer Ibrahim; Michael Nodzenski; John M Strasswimmer; Shang I Brian Jiang; Joel L Cohen; Brian J Albano; Priya Batra; Ramona Behshad; Anthony V Benedetto; C Stanley Chan; Suneel Chilukuri; Courtney Crocker; Hillary W Crystal; Anir Dhir; Victoria A Faulconer; Leonard H Goldberg; Chandra Goodman; Steven S Greenbaum; Elizabeth K Hale; C William Hanke; George J Hruza; Laurie Jacobson; Jason Jones; Arash Kimyai-Asadi; David Kouba; James Lahti; Kristi Macias; Stanley J Miller; Edward Monk; Tri H Nguyen; Gagik Oganesyan; Michelle Pennie; Katherine Pontius; William Posten; Jennifer L Reichel; Thomas E Rohrer; James A Rooney; Hien T Tran; Emily Poon; Diana Bolotin; Meghan Dubina; Natalie Pace; Natalie Kim; Wareeporn Disphanurat; Ummul Kathawalla; Rohit Kakar; Dennis P West; Emir Veledar; Simon Yoo
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-10-2
Journal Detail:
Title:  JAMA dermatology (Chicago, Ill.)     Volume:  -     ISSN:  2168-6084     ISO Abbreviation:  JAMA Dermatol     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101589530     Medline TA:  JAMA Dermatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Department of Dermatology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois2Department of Otolaryngology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois3Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois4Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
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