Immunosuppression ups risk of complications after Mohs micrographic surgery
Immunosuppressed patients are at increased risk for postoperative complications, such as surgical site infection and wound dehiscence, following Mohs micrographic surgery (MMS) due to solid organ transplant and immunosuppressive therapy use, according to a new study.
In univariable analysis, immunosuppression correlated with 9.6-fold increased odds of postoperative complication (p=0.003) compared with immunocompetence, with solid organ transplant recipients having 8.824 times higher odds (p=0.006) and immunosuppressive therapy users showing 5.775 times higher odds (p=0.021). Immunosuppressed patients were at increased risk of surgical site infection (2.5 percent) and dehiscence (0.51 percent), with an overall complication rate of 5.4 percent in the said population.
Multivariable analysis showed a statistically nonsignificant association between immunosuppression and postoperative complication (p=0.056).
An earlier study also found a higher risk for complications in large tumours following MMS owing to their increased size and need for repair with methods other than linear closures. In contrast, tumours with aggressive subclinical extension were not at greater risk for postoperative complications. [J Drugs Dermatol 2018;17:511-515]
The investigators conducted a retrospective cross-sectional chart review of patient characteristics, clinical characteristics and complications to determine the incidence and nature of postoperative complications in immunosuppressed patients undergoing MMS.
The study was limited by its single-centre, retrospective design, as well as the lack of nonsolid organ transplants, limited medication-related data on nontransplant patients, and exclusion of cases involving patients with double transplants or multiple sources of immunosuppression.
“Many patients undergoing MMS for basal and squamous cell carcinomas are immunocompromised, yet postoperative complications associated with different types of immunosuppression are largely unstudied,” the investigators said.