Fronek Lisa, Davis Michael J, Greenway Hubert T, Kelley Benjamin
Department of Dermatology, Scripps Clinic Torrey Pines Bighorn Mohs Surgery and Dermatology, San Diego, California.
Department of Dermatology, Memorial Sloan Kettering, Mohs Micrographic Surgery, New York, New York.
JAAD Int. 2024 Mar 28;16:155-162. doi: 10.1016/j.jdin.2024.03.011. eCollection 2024 Sep.
While there is a higher risk of surgical site infection (SSI) on the lower extremities following Mohs micrographic surgery (MMS), antibiotic prophylaxis (AP) is debated.
To determine the role of shared decision making (SDM) in guiding AP usage during MMS on the lower extremities.
A prospective observational study was conducted whereby patients received a standardized SDM discussion or routine counseling. Patient satisfaction quantified by the shared decision-making questionnaire (SDMQ9) survey, rate of SSI, and rate of AP prescription were recorded.
In total, 51 patients were included. While there were less antibiotics prescribed in the treatment group (20% versus 50%, = .025), this did not affect incidence of SSI (8% in treatment group versus 7.7% in control group, = .668). Patient satisfaction was statistically greater in SDM group (4.73 versus 2.18 in control ( < .001).
Patient satisfaction scores were higher among the patients who received SDM. While the usage of AP was lower in the SDM group, this did not affect incidence of SSI. This study allows the opportunity to apply SDM in the setting of MMS, which to our knowledge has not yet been attempted in the field of dermatologic surgery.
虽然莫氏显微外科手术（MMS）后下肢手术部位感染（SSI）的风险较高，但抗生素预防（AP）仍存在争议。
确定共同决策（SDM）在指导下肢MMS期间AP使用中的作用。
进行了一项前瞻性观察性研究，患者接受标准化的SDM讨论或常规咨询。记录通过共同决策问卷（SDMQ9）调查量化的患者满意度、SSI发生率和AP处方率。
总共纳入了51名患者。虽然治疗组开具的抗生素较少（20%对50%，P = 0.025），但这并未影响SSI的发生率（治疗组为8%，对照组为7.7%，P = 0.668）。SDM组的患者满意度在统计学上更高（4.73对对照组的2.18，P < 0.001）。
接受SDM的患者的满意度得分更高。虽然SDM组中AP的使用较低，但这并未影响SSI的发生率。本研究为在MMS环境中应用SDM提供了机会，据我们所知，这在皮肤科手术领域尚未尝试过。
