63 participants completed the survey at routine wound care visits one to two weeks following Mohs Surgery. The majority of participants (70%) reported high adherence and only 8% reported low adherence to wound care instructions following Mohs surgery.
Clinical Pearls
This prospective cohort study used a questionnaire to investigate the frequency and primary drivers of non-adherence to wound care following Mohs micrographic surgery.
63 participants completed the survey at routine wound care visits one to two weeks following Mohs Surgery. The majority of participants (70%) reported high adherence and only 8% reported low adherence to wound care instructions following Mohs surgery.
Using a scale to assess patient frailty, this study also found that increasing frailty was associated with low adherence to wound care following Mohs surgery.
Discussion:
Wound care adherence is a vital component of the healing process following Mohs micrographic surgery (MMS). In this prospective cohort study, Chen et al. aimed to better understand non-adherence to wound care following MMS and possible associated causative factors as well as postoperative complications. The authors cited past studies suggesting low adherence to wound care in dermatologic patients, but emphasized how no past studies have investigated compliance with wound care following MMS.
Over a 2 month period, patients who underwent MMS within the Department of Dermatology at the University of Massachusetts Chan Medical School were asked to complete a questionnaire at routine wound care visits one to two weeks following MMS. Using an 8-item Morisky Medication Adherence Scale, the authors measured each participants adherence to wound care practices. Patients were subsequently categorized as having high adherence, medium adherence, or low adherence.
Additionally, the authors included a measurement of patient frailty using a FRAIL scale, categorizing patients as robust, prefrail, or frail. Post-operative complications were also recorded for any patient included within the study.
63 patients were included in this study, with 69.8% (44) demonstrating high adherence, 22.2 % (14) demonstrating medium adherence, and 7.9% (5) demonstrating low adherence. Interestingly, an increased likelihood of high adherence was found for every 10 year increase in age. Additionally, receiving assistance with wound care was a significant predictor for high adherence. On the other hand, frailty was found to be associated with a decreased likelihood of high adherence. Only one post-operative complication was observed.
In summary, this study provides insightful data on adherence levels of MMS patients to wound care following surgery.
This study was a single-center, single-surgeon study with a relatively small sample size, potentially limiting generalizability. Additionally, the authors recognized patients may have over-reported wound care adherence to seem compliant to their provider.
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