Outpatient setting very safe for skin canc...( id Cook but this study shows the rari...)

Outpatient setting very safe for skin cancer surgery

id Cook, "but this study shows the rarity of complications that occur with Mohs surgery performed by an appropriately trained physician.

"We all see reports in the news of undesired patient outcomes following surgery," Cook continued. "Although dermatologic surgery is largely not responsible for these cases, people tend to generalize and assume that all outpatient surgery is dangerous."

The Duke team tracked each Mohs surgical procedure performed during 2000 and logged clinical observations regarding complications into a database. Complications were evaluated and treated by the physicians. In addition to general information about the area of the surgery and type and size of cancer removed, the researchers recorded information about the occurrence of the six types of complications most likely to follow Mohs surgery:

Post-operative hemorrhage -- significant bleeding that required treatment by a physician in the post-operative period

Hematoma -- painful swelling that indicated significant delayed bleeding at the operative site

Wound dehiscence -- partial or complete separation of the wound edges after sutures had been placed

Wound infection -- an infection of the surgical site

Skin flap or skin graft necrosis -- partial tissue loss of skin used to reconstruct the surgical wound after the cancer had been removed

Of the 22 complications that occurred during the study period, the majority involved difficulties with excess bleeding. None of the patients required hospitalization or consultation with another physician.

The researchers note that outpatient settings may be not only more comfortable and accessible to patients than hospitals, but that they also may be a more cost-effective location for providing quality care for Mohs patients.

"In the overwhelming majority of patients, there really is no need for this type of surgery to be performed in an inpatient setting," said Cook.

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Contact: Laura Sawyer Brinn or Amy Austell
laura.brinn@duke.edu
919-684-4148
Duke University Medical Center
17-Feb-2003

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