Dermatologic surgeryProspective evaluation of dermatologic surgery complications including patients on multiple antiplatelet and anticoagulant medications
Section snippets
Patients enrolled
Institutional review board approval was obtained March 12, 2006, from the Committee for the Protection of Human Subjects in Research at the University of Massachusetts Medical School. All patients presenting to the University of Massachusetts Medical School Dermatology Clinic (academic group practice) from March 15, 2006, to June 15, 2007, were eligible for the study. Patients undergoing MMS or scalpel-based excisional surgery requiring sutures were included. MMS patients were excluded from the
Descriptive statistics
During the 15-month period, 1911 patients meeting inclusion criteria were included in the study. Of the 1911, 1369 (72%) had undergone MMS, and 542 (28%) underwent surgical excision. The majority (68%) of surgical closures were intermediate-layered, whereas 20% were flaps, grafts, or both (Fig 1). The most common anatomic sites of surgery were the nose (21%), cheek (16%), forehead (15%), and back (8%) (Fig 2). In all, 731 (38%) of patients were on one anticoagulant or antiplatelet medication,
Discussion
The findings of our study are the most generalizable of their kind to date. The surgeons performing the MMS and excisions were two fellowship-trained Mohs surgeons, two MMS fellows, and 4 general dermatologists who perform excisions. Other studies examining complications have included data from surgeries by only one or two physicians, often Mohs surgeons.13, 14 Also, we did not discontinue anticoagulant medications before surgery. Many patients are now continued on these medications because of
Conclusion
Dermatologic surgery in the outpatient setting has very low rates of complications. Hemorrhagic complications are rare, even when anticoagulant and antiplatelet medications are continued. Complex, flap, graft, and partial closure types; warfarin use; and clopidogrel use increase the risk of hemorrhage. Patients taking both warfarin and clopidogrel have an even higher risk of bleeding, and care should be taken when operating on these patients. However, given the risk of thrombotic events, we
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Funding sources: None.
Conflicts of interest: None declared.
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