Prospective evaluation of dermatologic surgery complications including patients on multiple antiplatelet and anticoagulant medications

被引:109
作者
Bordeaux, Jeremy S. [1 ,2 ]
Martires, Kathryn J. [2 ]
Goldberg, Dori [3 ]
Pattee, Sean F. [4 ]
Fu, Pingfu [2 ]
Maloney, Mary E. [3 ]
机构
[1] Univ Hosp Case Med Ctr, Dept Dermatol, Cleveland, OH 44106 USA
[2] Case Western Reserve Univ, Sch Med, Cleveland, OH USA
[3] Univ Massachusetts, Sch Med, Dept Med, Div Dermatol, Worcester, MA USA
[4] Dermatol Associates Wisconsin, Manitowoc, WI USA
关键词
antibiotic prophylaxis; anticoagulant agents; antiplatelet agents; blood thinners; flaps; grafts; surgical complications; surgical infection; wound dehiscence; CUTANEOUS SURGERY; PERIOPERATIVE MANAGEMENT; ANTIBIOTIC-PROPHYLAXIS; SITE COMPLICATIONS; SKIN SURGERY; WARFARIN; ASPIRIN; THERAPY; PREVENTION; SMOKING;
D O I
10.1016/j.jaad.2011.02.012
中图分类号
R75 [皮肤病学与性病学];
学科分类号
100206 ;
摘要
Background: Few prospective studies have evaluated the safety of dermatologic surgery. Objective: We sought to determine rates of bleeding, infection, flap and graft necrosis, and dehiscence in outpatient dermatologic surgery, and to examine their relationship to type of repair, anatomic location of repair, antibiotic use, antiplatelet use, or anticoagulant use. Methods: Patients presenting to University of Massachusetts Medical School Dermatology Clinic for surgery during a 15-month period were prospectively entered. Medications, procedures, and complications were recorded. Results: Of the 1911 patients, 38% were on one anticoagulant or antiplatelet medication, and 8.0% were on two or more. Risk of hemorrhage was 0.89%. Complex repair (odds ratio [OR] = 5.80), graft repair (OR = 7.58), flap repair (OR = 11.93), and partial repair (OR = 43.13) were more likely to result in bleeding than intermediate repair. Patients on both clopidogrel and warfarin were 40 times more likely to have bleeding complications than all others (P = .03). Risk of infection was 1.3%, but was greater than 3% on the genitalia, scalp, back, and leg. Partial flap necrosis occurred in 1.7% of flaps, and partial graft necrosis occurred in 8.6% of grafts. Partial graft necrosis occurred in 20% of grafts on the scalp and 10% of grafts on the nose. All complications resolved without sequelae. Limitations: The study was limited to one academic dermatology practice. Conclusion: The rate of complications in dermatologic surgery is low, even when multiple oral anticoagulant and antiplatelet medications are continued, and prophylactic antibiotics are not used. Closure type and use of warfarin or clopidogrel increase bleeding risk. However, these medications should be continued to avoid adverse thrombotic events. (J Am Acad Dermatol 2011;65:576-83.)
引用
收藏
页码:576 / 583
页数:8
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