Postoperative complications: Academic audit identifies surgical standards, risk factors

November 1, 2008

An audit conducted at a university dermatology department suggests that certain factors appear to increase patients' risk of postoperative complications, one of the audit's authors says. However, antibiotic use may reduce such complications, he adds.

Key Points

The audit also identifies smoking, lesion size and basal cell carcinoma (BCC) as possible risks for postoperative complications, says Anton B. Alexandroff, M.D., Ph.D., a specialist registrar (U.S. equivalent: fellow) in dermatology at Leicester University Hospital, Leicester, England.

The pilot study evaluated surgical standards in the University Hospital of North Durham dermatology department, Dr. Alexandroff says.

Hence, the department wanted to examine the role of these factors in its surgical outcomes, Dr. Alexandroff says.

"Our colleagues did similar studies in the past," he says, "and they didn't get statistically significant results. But there was a trend" that department officials hoped a larger audit could substantiate.

More specifically, Dr. Alexandroff says, "We didn't know whether we would obtain similar results or not, how many procedures we'd need to audit to obtain statistically significant results, or whether we'd need to take it to the next level - a formal clinical trial - to compare treatments."

Study parameters

To address these issues, Dr. Alexandroff and colleague Wei Jing Loo, M.D., of the University Hospital of North Durham, England, conducted a prospective audit of postoperative complications of 106 consecutive dermatological procedures (involving 89 patients) performed within one month in the University Hospital of North Durham dermatology department.

All patients completed a standard informational form preoperatively. Then researchers interviewed them by telephone within three weeks after surgery.

For starters, Dr. Alexandroff tells Dermatology Times, "We asked whether they experienced prolonged bleeding that wasn't easily controlled."

Bleeding

Minor bleeding that stops with application of pressure occurs fairly commonly after dermatologic surgery procedures, he says.

"On the other hand," he says, "if it requires prolonged pressure or a visit to a general practitioner (GP) or a casualty department - or if it interferes significantly with a patient's lifestyle - that's a different matter."

Infections

Interviewers also inquired about symptoms of postoperative infections (pain, erythema and swelling), as well as whether patients sought postoperative medical attention from the university or elsewhere.

For those who returned to the university hospital, Dr. Alexandroff says, "We could objectively conclude whether they had infection clinically, and take microbiological cultures as well."

For patients who saw GPs, researchers asked these doctors to verify patients' reported complications and briefly describe how the GPs treated these problems. If researchers couldn't reach patients by phone, they followed up by mail.

Procedures studied

Procedures studied included 36 excisions, 43 punch biopsies, 13 incisional biopsies, eight shave excisions and six curettages. Three patients (2.8 percent) experienced localized wound infection. One patient (0.9 percent) developed wound dehiscence.

Risk factors

Although the study's numbers were too small to reach statistical significance, several factors showed a trend toward increased risk of wound infection. These include the following:

In addition, lesion sizes greater than 15 mm also were associated with increased postoperative complications.

Conversely, postoperative use of either oral or topical antibiotics reduced the risk of infection.

Additionally, age, gender, anticoagulation therapy and the clinical grade of the surgeon appeared to have no impact on the rate of postoperative consultations.