The characteristics of a wound 7 days post-op that most Mohs surgeons agreed were consistent with SSI were warmth, swelling, erythema, and pain with purulent discharge that was Staphylococcus Aureus positive (100% agreement). 76% of Mohs surgeons agreed that warmth, swelling, erythema, and pain with serosanguinous discharge that was not cultured constituted a SSI
Clinical Pearls
79 Mohs surgeons completed a web-based survey responding to different scenarios that could represent surgical site infection after Mohs micrographic surgery
The characteristics of a wound 7 days post-op that most Mohs surgeons agreed were consistent with SSI were warmth, swelling, erythema, and pain with purulent discharge that was Staphylococcus Aureus positive (100% agreement). 76% of Mohs surgeons agreed that warmth, swelling, erythema, and pain with serosanguinous discharge that was not cultured constituted a SSI
78.5% of Mohs surgeons did not report having a standardized criteria for surgical site infection used by all providers at their practice and 91% of Mohs surgeons stated they do not require positive wound cultures to diagnose surgical site infections
Discussion:
In this national survey completed by Hanly et al, the authors aimed to better understand how Mohs surgeons across the United States define surgical site infections (SSI). The authors referenced how SSIs are the most common complication of Mohs micrographic surgery (MMS), however, there is currently no consensus among Mohs surgeons on how to define SSI.
Initially, a web-based anonymous voluntary survey was created and provided to a national expert panel of five Mohs surgeons. Following feedback, the 19-question survey was sent via email to the American College of Mohs Surgery membership directory. The survey used a 5-point Likert scale to rate different scenarios related to possible surgical site infections following Mohs surgery. All scenarios used started with the following statement: “A 65-year-old female who underwent Mohs micrographic surgery on the left cheek to remove a basal cell carcinoma. The patient returned for a follow-up appointment 7 days post-operatively”.
Out of 1,500 potential survey respondents, 79 responded (5.3%). The scenarios which most Mohs surgeons believed were consistent with a SSI were warmth, swelling, erythema, and pain without discharge (79.7%); warmth, swelling, erythema, and pain with serosanguinous discharge that was not cultured (76%); warmth, swelling, erythema, and pain with purulent discharge that was not cultured (97.5%); warmth, swelling, erythema, and pain with purulent discharge that was Staphylococcus aureus positive (100%); warmth, swelling, erythema, and pain with purulent discharge that was culture negative (70.9%); and warmth, swelling, erythema, pain, and fever with no culture data (86.1%).
The authors found that 78.5% of Mohs surgeons did not report having have a standardized criteria for surgical site infections. Additionally, 91% of Mohs surgeons stated they did not require positive wound cultures to diagnose an SSI. Limitations of this study include a low response rate (5.3%) and a survey limited in scope of possible surgical site infections.
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