Evaluating complications in below‐knee skin cancer surgery after introduction of preoperative appointments: A 2‐year retrospective cohort study

• Published in: International wound journal 2020-04, Vol.17 (2), p.363-369
• Main Authors: Lindholm, Vivian M., Isoherranen, Kirsi M., Schröder, Marika T., Pitkänen, Sari T.
• Format: Article
• Language: English
• Subjects: Aged; Appointments and Schedules; below‐knee; Dermatologic Surgical Procedures - adverse effects; dermatological surgery; Female; Finland - epidemiology; Follow-Up Studies; Humans; Incidence; Male; Original; Postoperative Care - methods; Postoperative Complications - diagnosis; Postoperative Complications - epidemiology; preoperative evaluation; prevention; Prognosis; Retrospective Studies; Risk Factors; Skin Neoplasms - surgery; wound healing
• ISSN: 1742-4801; 1742-481X
• DOI: 10.1111/iwj.13280

Below‐knee dermatological surgery has a high risk of complications such as wound infection, bleeding, and necrosis. In this study, we evaluated the impact of preoperative appointments on complication risks. We searched the medical records of the Helsinki University Central Hospital (HUS) Dermatosurgery unit for all below‐knee surgeries during 2016, when no preoperative nurse appointments were carried out, and compared it with 2018, when preoperative appointments for risk patients were introduced. The study included 187 patients in 2016 and 179 patients in 2018, of whom 68 (about one third) attended preoperative appointments. At the appointments, risk factors were evaluated, and compression therapy was introduced when possible. The results show complication rates of 13.4% in 2016 vs 10.1% in 2018 (P = .33), despite significantly higher risks in the 2018 patient group. The odds ratio for complications in appointment attendees vs non‐attendees was reduced after adjustments to 0.58; however, this was insignificant (P = .47). The odds of complications for skin grafts were considerably higher: 11.33 vs other surgery techniques (P = .00). In conclusion, the introduction of preoperative appointments appeared to reduce complications in below‐knee surgery. For graft reconstructions, complication risk is high, even with carefully planned pre‐ and postoperative care. Further studies are needed to evaluate preventable risk factors of below‐knee graft reconstructions.