A 4-year retrospective assessment of postoperative complications in immunosuppressed patients following Mohs micrographic surgery

• Published in: Journal of the American Academy of Dermatology 2019-06, Vol.80 (6), p.1594-1601
• Main Authors: Basu, Pallavi, Goldenberg, Alina, Cowan, Natasha, Eilers, Robert, Hau, Jennifer, Jiang, Shang I Brian
• Format: Article
• Language: English
• Subjects: dermatologic surgery; immunosuppression; Mohs micrographic surgery
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2018.11.032

Many patients undergoing Mohs micrographic surgery for basal and squamous cell carcinomas are immunocompromised, yet postoperative complications associated with different types of immunosuppression are largely unstudied. To determine the incidence and nature of postoperative complications in immunosuppressed patients undergoing Mohs micrographic surgery. A retrospective cross-sectional chart review of patient characteristics, clinical characteristics, and complications. Univariable analysis showed that compared with immunocompetence, immunosuppression was associated with 9.6 times the odds of postoperative complication (P = .003), with solid organ transplant recipients having 8.824 times higher odds (P = .006) and immunosuppressive therapy use displaying 5.775 times higher odds (P = .021). Surgical site infection (2.5%) and dehiscence (0.51%) were more prevalent among immunosuppressed patients, with an overall complication rate of 5.4% in the immunosuppressed population. Multivariable analysis of the association between immunosuppression and postoperative complication closely trended toward, but did not meet, significance (P = .056). This was a single-center, retrospective study. Other limitations include lack of non–solid organ transplants, limited medication-related data on nontransplant patients, and exclusion of cases involving patients with double transplants or multiple sources of immunosuppression. Immunosuppression overall, particularly owing to solid organ transplant and immunosuppressive therapy use, places patients at higher risk for postoperative complications, including surgical site infection and wound dehiscence following MMS.