Office based dermatological surgery and Mohs surgery: A prospective audit of surgical procedures and complications in a procedural dermatology practice

Abstract

Dermatologists commonly perform surgical procedures, including Mohs micrographic surgery, in an outpatient, office-based setting. Although this may be widely perceived to be safe and effective, formal data on the practice are limited. The aim of this study was to examine the range of surgical procedures and associated complications in an Australian specialist dermatology and Mohs surgery practice. All surgical procedures over a 55-week period were prospectively logged, with data collection on sex, age, type of procedure, body site, diagnosis and complications. All procedures were performed under conditions that were usual for the practice, with a combination of sterile and clean surgical techniques, depending on the procedure. In all, 2370 surgical procedures were performed during the study period, including 934 Mohs surgery cases. Most procedures (68%) were performed on head and neck sites. A total of 56 complications were recorded in 51 patients. Bacterial wound infections occurred in 13 cases (0.5%). Bleeding complications occurred in five cases (0.2%). There were no complications requiring hospital admission or i.v. antibiotics. This study supports the view that dermatological surgery, including significant procedures such as Mohs micrographic surgery, flaps and grafts, can be performed on an ambulatory basis in an office-based procedure room setting, with low complication rates.