Clinic-based surgery for hidradenitis suppurativa (HS) was well tolerated and associated with high rates of patient satisfaction, according to study findings published in JAMA Dermatology.
The retrospective cohort study included patients aged 12 years or older who met the clinical criteria for HS and underwent surgical intervention at a university dermatology clinic from April 2014 to December 2018.
Patient-reported recurrence of HS at the site of surgery, satisfaction with the procedures and outcomes, and self-reported pain and recovery associated with surgery were the primary outcomes. Questionnaires regarding the patients’ experience with the surgery were administered in the clinic or by telephone.
A total of 78 patients completed surveys (mean [SD] age, 35.1 [12.1] years; 83% women) and were included in the analysis. Data for 194 independent surgical procedures were obtained from the participants. Overall, the rate of patient-reported disease recurrence at the previous surgical site was 41% (79 procedures).
Bivariate analyses showed a negative association between recurrence and age older than 35 years (odds ratio [OR], 0.21; 95% CI, 0.10-0.48; P = .01). Patients aged 35 years or older were significantly less likely to have recurrence (OR, 0.19; 95% CI, 0.08-0.49; P = .003) vs those aged younger than 25 years. The odds of recurrence were 4.38 (95% CI, 1.02-18.29; P = .04) times higher for patients who had excisions without closure vs those who had deroofing.
The patients had a median time to return to work or school of 2 days (interquartile range [IQR], 1-7 days), a median of 10 days (IQR, 3-14 days) to resume normal activities, and a median of 30 days (IQR, 14-45 days) for their skin to completely heal.
Most patients responded that they would recommend the surgery to a friend (163 of 194 procedures [84%]), have the surgery again (162 procedures [84%]), were glad that they had the surgery (166 procedures [86%]), and thought that the surgery met their expectations (158 procedures [81%]).
Age older than 35 years (OR, 4.93; 95% CI, 1.45-16.79; P = .01) and obesity class 3 (body mass index ≥40) (OR, 4.48; 95% CI, 1.21-16.52; P = .02) were associated with higher odds of satisfaction with the surgery.
Patients reported having a pain level of 8 or higher (scale of 1 to 10, with 10 representing the worst pain) during their first week of recovery in 63 procedures (32%). In 126 procedures (65%), the participants reported that they believed the pain they had during an HS flare was worse than their surgical recovery pain.
The study was limited by the use of 1 institution for procedures performed by 1 surgeon in a subspecialty HS clinic. In addition, responses were received from 78 of 201 eligible patients, and so reporting bias may have occurred. Furthermore, the multiple analyses may have contributed to some borderline significant P values being attributable to chance alone, the researchers noted.
“Most patients were satisfied or very satisfied with surgical outcomes,” stated the researchers. “Current smoking was associated with an increased risk of dissatisfaction, although most patients were still satisfied.”
Disclosure: Two of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Ravi S, Miles JA, Steele C, Christiansen MK, Sayed CJ. Patient impressions and outcomes after clinic-based hidradenitis suppurativa surgery. JAMA Dermatol. Published online January 5, 2022. doi:10.1001/jamadermatol.2021.4741