Adverse events associated with mohs micrographic surgery

Multicenter Prospective Cohort Study of 20 821 Casesat 23 Centers

Murad Alam*, Omer Ibrahim, Michael Nodzenski, John M. Strasswimmer, Shang I.Brian Jiang, Joel L. Cohen, Brian J. Albano, Priya Batra, Ramona Behshad, Anthony V. Benedetto, C. Stanley Chan, Suneel Chilukuri, Courtney Crocker, Hillary W. Crystal, Anir Dhir, Victoria A. Faulconer, Leonard H. Goldberg, Chandra Goodman, Steven S. Greenbaum, Elizabeth K. Hale & 30 others C. William Hanke, George J. Hruza, Laurie Jacobson, Jason Jones, Arash Kimyai-Asadi, David Kouba, James Lahti, Kristi Macias, Stanley J. Miller, Edward Monk, Tri H. Nguyen, Gagik Oganesyan, Michelle Pennie, Katherine Pontius, William Posten, Jennifer L. Reichel, Thomas E. Rohrer, James A. Rooney, Hien T. Tran, Emily Poon, Diana Bolotin, Meghan Dubina, Natalie Pace, Natalie Kim, Wareeporn Disphanurat, Ummul Kathawalla, Rohit Kakar, Dennis P. West, Emir Veledar, Simon Yoo

*Corresponding author for this work

Research output: Contribution to journalArticle

55 Citations (Scopus)

Abstract

Importance Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications ofMMSare anecdotal or report findings from single centers or single events. Objectives To quantify adverse events associated with MMS and detect differences relevant to safety. Design, Setting, And Participants Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. Exposure Mohs micrographic surgery. Main Outcomes And Measures Intraoperative and postoperative minor and serious adverse events. Results Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. Conclusions And Relevance Mohs micrographic surgery is safe, with a very lowrate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate.Commoncomplications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely duringMMS.We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changeswould be cost-effective given the small risk reductions.

Original languageEnglish (US)
Pages (from-to)1378-1385
Number of pages8
JournalJAMA dermatology
Volume149
Issue number12
DOIs
StatePublished - Dec 1 2013

Fingerprint

Mohs Surgery
Cohort Studies
Prospective Studies
Wound Healing
Hemorrhage
Local Anti-Infective Agents
Risk Reduction Behavior
Anti-Bacterial Agents
Infection
Hematoma
Necrosis
Referral and Consultation
Outcome Assessment (Health Care)
Safety
Costs and Cost Analysis
Mortality

ASJC Scopus subject areas

  • Dermatology

Cite this

Alam, Murad ; Ibrahim, Omer ; Nodzenski, Michael ; Strasswimmer, John M. ; Jiang, Shang I.Brian ; Cohen, Joel L. ; Albano, Brian J. ; Batra, Priya ; Behshad, Ramona ; Benedetto, Anthony V. ; Chan, C. Stanley ; Chilukuri, Suneel ; Crocker, Courtney ; Crystal, Hillary W. ; Dhir, Anir ; Faulconer, Victoria A. ; Goldberg, Leonard H. ; Goodman, Chandra ; Greenbaum, Steven S. ; Hale, Elizabeth K. ; Hanke, C. William ; Hruza, George J. ; Jacobson, Laurie ; Jones, Jason ; Kimyai-Asadi, Arash ; Kouba, David ; Lahti, James ; Macias, Kristi ; Miller, Stanley J. ; Monk, Edward ; Nguyen, Tri H. ; Oganesyan, Gagik ; Pennie, Michelle ; Pontius, Katherine ; Posten, William ; Reichel, Jennifer L. ; Rohrer, Thomas E. ; Rooney, James A. ; Tran, Hien T. ; Poon, Emily ; Bolotin, Diana ; Dubina, Meghan ; Pace, Natalie ; Kim, Natalie ; Disphanurat, Wareeporn ; Kathawalla, Ummul ; Kakar, Rohit ; West, Dennis P. ; Veledar, Emir ; Yoo, Simon. / Adverse events associated with mohs micrographic surgery : Multicenter Prospective Cohort Study of 20 821 Casesat 23 Centers. In: JAMA dermatology. 2013 ; Vol. 149, No. 12. pp. 1378-1385.
@article{540d0cf6d222408e8db2d22df8352494,
title = "Adverse events associated with mohs micrographic surgery: Multicenter Prospective Cohort Study of 20 821 Casesat 23 Centers",
abstract = "Importance Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications ofMMSare anecdotal or report findings from single centers or single events. Objectives To quantify adverse events associated with MMS and detect differences relevant to safety. Design, Setting, And Participants Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. Exposure Mohs micrographic surgery. Main Outcomes And Measures Intraoperative and postoperative minor and serious adverse events. Results Among 20 821 MMS procedures, 149 adverse events (0.72{\%}), including 4 serious events (0.02{\%}), and no deaths were reported. Common adverse events reported were infections (61.1{\%}), dehiscence and partial or full necrosis (20.1{\%}), and bleeding and hematoma (15.4{\%}). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. Conclusions And Relevance Mohs micrographic surgery is safe, with a very lowrate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate.Commoncomplications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely duringMMS.We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changeswould be cost-effective given the small risk reductions.",
author = "Murad Alam and Omer Ibrahim and Michael Nodzenski and Strasswimmer, {John M.} and Jiang, {Shang I.Brian} and Cohen, {Joel L.} and Albano, {Brian J.} and Priya Batra and Ramona Behshad and Benedetto, {Anthony V.} and Chan, {C. Stanley} and Suneel Chilukuri and Courtney Crocker and Crystal, {Hillary W.} and Anir Dhir and Faulconer, {Victoria A.} and Goldberg, {Leonard H.} and Chandra Goodman and Greenbaum, {Steven S.} and Hale, {Elizabeth K.} and Hanke, {C. William} and Hruza, {George J.} and Laurie Jacobson and Jason Jones and Arash Kimyai-Asadi and David Kouba and James Lahti and Kristi Macias and Miller, {Stanley J.} and Edward Monk and Nguyen, {Tri H.} and Gagik Oganesyan and Michelle Pennie and Katherine Pontius and William Posten and Reichel, {Jennifer L.} and Rohrer, {Thomas E.} and Rooney, {James A.} and Tran, {Hien T.} and Emily Poon and Diana Bolotin and Meghan Dubina and Natalie Pace and Natalie Kim and Wareeporn Disphanurat and Ummul Kathawalla and Rohit Kakar and West, {Dennis P.} and Emir Veledar and Simon Yoo",
year = "2013",
month = "12",
day = "1",
doi = "10.1001/jamadermatol.2013.6255",
language = "English (US)",
volume = "149",
pages = "1378--1385",
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Alam, M, Ibrahim, O, Nodzenski, M, Strasswimmer, JM, Jiang, SIB, Cohen, JL, Albano, BJ, Batra, P, Behshad, R, Benedetto, AV, Chan, CS, Chilukuri, S, Crocker, C, Crystal, HW, Dhir, A, Faulconer, VA, Goldberg, LH, Goodman, C, Greenbaum, SS, Hale, EK, Hanke, CW, Hruza, GJ, Jacobson, L, Jones, J, Kimyai-Asadi, A, Kouba, D, Lahti, J, Macias, K, Miller, SJ, Monk, E, Nguyen, TH, Oganesyan, G, Pennie, M, Pontius, K, Posten, W, Reichel, JL, Rohrer, TE, Rooney, JA, Tran, HT, Poon, E, Bolotin, D, Dubina, M, Pace, N, Kim, N, Disphanurat, W, Kathawalla, U, Kakar, R, West, DP, Veledar, E & Yoo, S 2013, 'Adverse events associated with mohs micrographic surgery: Multicenter Prospective Cohort Study of 20 821 Casesat 23 Centers', JAMA dermatology, vol. 149, no. 12, pp. 1378-1385. https://doi.org/10.1001/jamadermatol.2013.6255

Adverse events associated with mohs micrographic surgery : Multicenter Prospective Cohort Study of 20 821 Casesat 23 Centers. / Alam, Murad; Ibrahim, Omer; Nodzenski, Michael; Strasswimmer, John M.; Jiang, Shang I.Brian; Cohen, Joel L.; Albano, Brian J.; Batra, Priya; Behshad, Ramona; Benedetto, Anthony V.; Chan, C. Stanley; Chilukuri, Suneel; Crocker, Courtney; Crystal, Hillary W.; Dhir, Anir; Faulconer, Victoria A.; Goldberg, Leonard H.; Goodman, Chandra; Greenbaum, Steven S.; Hale, Elizabeth K.; Hanke, C. William; Hruza, George J.; Jacobson, Laurie; Jones, Jason; Kimyai-Asadi, Arash; Kouba, David; Lahti, James; Macias, Kristi; Miller, Stanley J.; Monk, Edward; Nguyen, Tri H.; Oganesyan, Gagik; Pennie, Michelle; Pontius, Katherine; Posten, William; Reichel, Jennifer L.; Rohrer, Thomas E.; Rooney, James A.; Tran, Hien T.; Poon, Emily; Bolotin, Diana; Dubina, Meghan; Pace, Natalie; Kim, Natalie; Disphanurat, Wareeporn; Kathawalla, Ummul; Kakar, Rohit; West, Dennis P.; Veledar, Emir; Yoo, Simon.

In: JAMA dermatology, Vol. 149, No. 12, 01.12.2013, p. 1378-1385.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Adverse events associated with mohs micrographic surgery

T2 - Multicenter Prospective Cohort Study of 20 821 Casesat 23 Centers

AU - Alam, Murad

AU - Ibrahim, Omer

AU - Nodzenski, Michael

AU - Strasswimmer, John M.

AU - Jiang, Shang I.Brian

AU - Cohen, Joel L.

AU - Albano, Brian J.

AU - Batra, Priya

AU - Behshad, Ramona

AU - Benedetto, Anthony V.

AU - Chan, C. Stanley

AU - Chilukuri, Suneel

AU - Crocker, Courtney

AU - Crystal, Hillary W.

AU - Dhir, Anir

AU - Faulconer, Victoria A.

AU - Goldberg, Leonard H.

AU - Goodman, Chandra

AU - Greenbaum, Steven S.

AU - Hale, Elizabeth K.

AU - Hanke, C. William

AU - Hruza, George J.

AU - Jacobson, Laurie

AU - Jones, Jason

AU - Kimyai-Asadi, Arash

AU - Kouba, David

AU - Lahti, James

AU - Macias, Kristi

AU - Miller, Stanley J.

AU - Monk, Edward

AU - Nguyen, Tri H.

AU - Oganesyan, Gagik

AU - Pennie, Michelle

AU - Pontius, Katherine

AU - Posten, William

AU - Reichel, Jennifer L.

AU - Rohrer, Thomas E.

AU - Rooney, James A.

AU - Tran, Hien T.

AU - Poon, Emily

AU - Bolotin, Diana

AU - Dubina, Meghan

AU - Pace, Natalie

AU - Kim, Natalie

AU - Disphanurat, Wareeporn

AU - Kathawalla, Ummul

AU - Kakar, Rohit

AU - West, Dennis P.

AU - Veledar, Emir

AU - Yoo, Simon

PY - 2013/12/1

Y1 - 2013/12/1

N2 - Importance Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications ofMMSare anecdotal or report findings from single centers or single events. Objectives To quantify adverse events associated with MMS and detect differences relevant to safety. Design, Setting, And Participants Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. Exposure Mohs micrographic surgery. Main Outcomes And Measures Intraoperative and postoperative minor and serious adverse events. Results Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. Conclusions And Relevance Mohs micrographic surgery is safe, with a very lowrate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate.Commoncomplications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely duringMMS.We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changeswould be cost-effective given the small risk reductions.

AB - Importance Detailed information regarding perioperative risk and adverse events associated with Mohs micrographic surgery (MMS) can guide clinical management. Much of the data regarding complications ofMMSare anecdotal or report findings from single centers or single events. Objectives To quantify adverse events associated with MMS and detect differences relevant to safety. Design, Setting, And Participants Multicenter prospective inception cohort study of 21 private and 2 institutional US ambulatory referral centers for MMS. Participants were a consecutive sample of patients presenting with MMS for 35 weeks at each center, with staggered start times. Exposure Mohs micrographic surgery. Main Outcomes And Measures Intraoperative and postoperative minor and serious adverse events. Results Among 20 821 MMS procedures, 149 adverse events (0.72%), including 4 serious events (0.02%), and no deaths were reported. Common adverse events reported were infections (61.1%), dehiscence and partial or full necrosis (20.1%), and bleeding and hematoma (15.4%). Most bleeding and wound-healing complications occurred in patients receiving anticoagulation therapy. Use of some antiseptics and antibiotics and sterile gloves during MMS were associated with modest reduction of risk for adverse events. Conclusions And Relevance Mohs micrographic surgery is safe, with a very lowrate of adverse events, an exceedingly low rate of serious adverse events, and an undetectable mortality rate.Commoncomplications include infections, followed by impaired wound healing and bleeding. Bleeding and wound-healing issues are often associated with preexisting anticoagulation therapy, which is nonetheless managed safely duringMMS.We are not certain whether the small effects seen with the use of sterile gloves and antiseptics and antibiotics are clinically significant and whether wide-scale practice changeswould be cost-effective given the small risk reductions.

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UR - http://www.scopus.com/inward/citedby.url?scp=84892172420&partnerID=8YFLogxK

U2 - 10.1001/jamadermatol.2013.6255

DO - 10.1001/jamadermatol.2013.6255

M3 - Article

VL - 149

SP - 1378

EP - 1385

JO - JAMA Dermatology

JF - JAMA Dermatology

SN - 2168-6068

IS - 12

ER -