SLR - December 2021 - Jacob R. Bolling
Reference: Schwartzman G, Khachemoune A. Surgical Site Infection After Dermatologic Procedures: Critical Reassessment of Risk Factors and Reappraisal of Rates and Causes. Am J Clin Dermatol. 2021 Jul;22(4):503-510.Level of Evidence: 3
Scientific Literature Review
Reviewed By: Jacob R. Bolling, DPM
Residency Program: Saint Vincent Hospital – Worcester, MA.
Podiatric Relevance: Podiatrists often perform excisions of a variety of skin lesions and/or soft tissue masses. The significance of this study to podiatry is that it evaluates the contributing factors to surgical site infections (SSIs) following dermatological surgeries. It also evaluates risk factors such as smoking history and diabetes, factors that are spoken about with patients by podiatrists commonly and are looked at when assessing risks for surgery. The purpose of this study was to review the current literature regarding surgical site infections in dermatologic procedures and provide guidance for care.
Methods: The study was performed using the PubMed database, utilizing the key phrases “surgical site infection” and “dermatologic surgery”. The search was conducted from December 10, 2020 to December 26, 2020 and included original articles and reviews. The authors aimed to provide guidance on wound culture, risk factors for infection, and antibiotic prophylaxis. The study determined that there is no universal agreement on the definition of SSI. Therefore, the study identified 41 definitions and 13 grading scales across several other studies.
Results: The authors found that complicated diabetic patients had higher risk of SSI, but non-complicated diabetic patients were at no further risk than non-diabetic patients. Strong evidence was shown for smoking as a risk factor for developing SSI in general, but not specifically for dermatological surgeries. Immunologic status is shown in some studies to be a risk factor, but the overall consensus is mixed. Antibiotic prophylaxis continues to not be universal amongst dermatologic surgeons. Inpatient surgeries, larger wounds, wedge excisions, and skin grafting are considered high risk. Use of cautery for dermatological surgeries may increase risk of SSI. Also performing surgeries under clean technique did not lead to increased risk of infection versus sterile technique for dermatologic surgeries using Mohs micrographic surgery.
Conclusions: Despite several factors being mentioned and analyzed within the study, it is apparent from some of the factors that more data is required to definitively assess their effect on risk of SSI. As the study suggests at several points, dermatologic surgeries are safe and accompanied by low rates of complications. With this, it is also noted that factors that increase risk in dermatological surgeries also increase risk in surgery in general. When concerning clean technique vs sterile technique, it is also noted that the difference is minimal in dermatologic surgeries but may play a larger role in more complex or longer procedures. The study comments that there is currently no solid understanding of a true infection rate following dermatologic surgery. The study suggests that a standardized approach and universal criteria be applied for evaluation of SSI. It is also suggested that more well-designed randomized controlled trials be performed in the future to help isolate clinically significant risk factors and help establish guidelines.