Ruan Qing Zhao, Chen Austin D, Singhal Dhruv, Lee Bernard T, Fukudome Eugene Y
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
J Surg Res. 2018 Sep;229:200-207. doi: 10.1016/j.jss.2018.04.007. Epub 2018 May 1.
Hidradenitis suppurativa (HS) is a chronic debilitating cutaneous disorder. The recalcitrant nature of this disease may require surgery in severe cases. We aimed to delineate the types of operations performed, the risk factors associated with these operations, and the surgical services involved based on a national database.
Data were collected through the American College of Surgeons National Surgical Quality Improvement Program from 2011 to 2016. Current Procedural Terminology (CPT) and International Classification of Disease, Ninth Revision, (ICD-9) codes were used for data extraction and analysis as type of surgery and complication rates were extracted.
There were 2594 patients diagnosed with HS: 1405 (54.2%) incision and drainage, 1017 (39.2%) debridement, 31 (1.2%) skin graft, and 141 (5.4%) flap reconstruction. There were significant differences in transfusion rates and operation time among the four procedures. Skin graft and flap reconstruction had the highest complications and longest operation time. Bleeding requiring preoperative transfusion and a number of comorbidities were significant risk factors for postoperative complications. Flap reconstructions by plastic surgeons compared to general surgeons had significantly shorter operation times (134.89 versus 209.82 min, P = 0.022) and lower transfusion rates (2.2% versus 12.8%, P = 0.024).
The management of HS can be complex and may require a multidisciplinary approach. Bleeding requiring preoperative transfusion and other baseline comorbidities are independent risk factors that should be addressed when definitive surgical treatment of hidradenitis is planned. Appropriate surgical specialty involvement may better optimize the surgical outcomes for HS.
化脓性汗腺炎（HS）是一种慢性致残性皮肤病。这种疾病的顽固性在严重病例中可能需要手术治疗。我们旨在根据一个全国性数据库来描述所进行的手术类型、与这些手术相关的风险因素以及所涉及的外科服务。
通过美国外科医师学会国家外科质量改进计划收集2011年至2016年的数据。使用当前手术操作术语（CPT）和国际疾病分类第九版（ICD - 9）编码进行数据提取和分析，提取手术类型和并发症发生率。
有2594例患者被诊断为HS：1405例（54.2%）切开引流，1017例（39.2%）清创术，31例（1.2%）植皮术，141例（5.4%）皮瓣重建术。这四种手术在输血率和手术时间上存在显著差异。植皮术和皮瓣重建术并发症最高且手术时间最长。术前需要输血的出血情况和一些合并症是术后并发症的重要风险因素。与普通外科医生相比，整形外科医生进行的皮瓣重建术手术时间明显更短（134.89分钟对209.82分钟，P = 0.022）且输血率更低（2.2%对12.8%，P = 0.024）。
HS的治疗可能很复杂，可能需要多学科方法。术前需要输血的出血情况和其他基线合并症是独立的风险因素，在计划对化脓性汗腺炎进行确定性手术治疗时应予以考虑。适当的外科专科参与可能会更好地优化HS的手术效果。
