Evaluating Postoperative Complication Risk in Patients with Nicotine Dependence That Undergo Mohs Micrographic Surgery
Author(s)
Garate D1, Thomas D2, Morgan B2, Flores I3, Fu S4, Golovko G5
1University of Texas Medical Branch John Sealy School of Medicine, Texas City, TX, USA, 2University of Texas Medical Branch John Sealy School of Medicine, Galveston, TX, USA, 3Sam Houston State University College of Osteopathic Medicine, Conroe, TX, USA, 4Baylor College of Medicine, Houston, TX, USA, 5University of Texas Medical Branch, Galveston, TX, USA
Presentation Documents
OBJECTIVES:
There is scant literature that evaluates postoperative outcomes in patients with nicotine dependence who undergo Mohs micrographic surgery (MMS), a tissue-sparing surgical technique commonly used to remove cutaneous neoplasms. Nicotine dependence is associated with many poor procedural outcomes, yet it is not well characterized in MMS. This study evaluated the postoperative complication risk in MMS recipients with vs. without nicotine dependence.METHODS:
TriNetX, a federated health research network database, was used to query patient outcomes from 56 HCOs on the US Collaborative Network subset. A retrospective cohort analysis was performed. Using validated ICD-10 diagnoses and CPT codes, cohort 1 was identified as patients with current nicotine dependence who underwent MMS, while the control group cohort 2 only included patients without nicotine dependence who underwent MMS. A 1:1 propensity score match analysis (PSM) was conducted adjusting for demographics and comorbidities and assessed for 30-day postoperative outcomes.RESULTS:
After PSM, we compared the two balanced cohorts of 19,567 patients. This study found MMS patients with nicotine dependence to be at greater risk of cellulitis/lymphangitis (aRR [95% CI]) = (1.56 [1.24-1.95]), cutaneous infection (1.52 [1.32-1.77]), wound hemorrhage (4.75 [4.25-5.31]), generalized muscle weakness (2.24 [1.58-3.19]), anesthesia (5.74 [4.87-6.75]) & paresthesia (2.66 [2.07-3.41]) of skin, rash eruption (3.61 [3.05-4.27]), localized swelling (2.69 [2.17-3.33]), skin graft complications (3.23 [1.74-6.02]), and acute post-procedural pain (2.22 [1.67-2.95]).CONCLUSIONS:
All tested postoperative outcomes demonstrated statistically significant (P<0.05) risk ratios indicating increased risk in the nicotine dependence cohort. These results suggest that patients with nicotine dependence are at increased risk for acute post-MMS complications within 30 days vs. patients without nicotine dependence. For current smokers being evaluated for MMS, the results of this study may help surgeons personalize their analysis of postoperative incision sites and give patients with nicotine dependence better counseling on the risks that they must consider prior to MMS.Conference/Value in Health Info
2023-05, ISPOR 2023, Boston, MA, USA
Value in Health, Volume 26, Issue 6, S2 (June 2023)
Code
EPH152
Topic
Real World Data & Information Systems
Topic Subcategory
Distributed Data & Research Networks, Reproducibility & Replicability
Disease
Geriatrics, Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory), Surgery