Clinic-based surgery for hidradenitis suppurativa (HS) had high patient satisfaction despite frequent recurrences, a retrospective cohort study showed.
Patients said they were highly satisfied with results of deroofing surgery and tissue excision procedures three-fourths of the time. The surgery was associated with a median time to return to work or school of 2 days, 10 days for resumption of normal activities, and 30 days for complete healing.
After almost two-thirds of procedures, patients said the pain of an HS flare was worse than the pain during the postoperative period and recovery, reported Christopher Sayed, MD, of the University of North Carolina at Chapel Hill, and coauthors in .
"In our experience, recurrences often result in more temporary or limited disease activity than that encountered before surgery, leading to overall benefit," the investigators stated. "In the present study, recurrence alone appeared to not be a marker of treatment failure given that satisfaction remained high."
In an that accompanied the article, Sayed said many patients with HS are apprehensive about surgery. At the same time, patients who might benefit from surgery are often "turned away." With that in mind, investigators sought to address three principal patient-centered issues: how long to return to work or school, how long to return to normal activities, and how long to wound healing.
"I wanted to be able to give them answers that would frame the issue in such a way that I would be able to discuss it with them," said Sayed.
"These patients are used to wound care -- that is normal care for them -- and if you give them a chance for the wound to fully heal after 4 to 6 weeks as opposed to a wound that never heals, it's a major upgrade for them ... rather than having them deal with a perpetual wound, wound care, and pain every day," he added.
Data for the retrospective analysis came from 194 surgical procedures in 78 patients at a single clinic from April 2014 through December 2018. The study population had a mean age of 35, and 83% of the patients were women. More than 80% of the procedures involved patients who were overweight or obese as defined by body mass index (BMI). A majority (60%) of the procedures involved patients with advanced-stage disease (Hurley stage 3), and more than half received tumor necrosis factor (TNF) inhibitors and antibiotics at the time of surgery, also indicators of advanced disease.
Two-thirds of the surgeries were deroofing procedures, 27% consisted of local excision with closer, and 6% were local excision without closure. Location of the surgery was the axilla in a third of procedures and the inguinal or pubic area in a fourth.
The primary outcomes were patient-reported recurrences, satisfaction with the surgery, and pain. On average, patients completed postoperative surveys 13 months after surgery.
The results showed 79 recurrences (41% of procedures). Recurrence was significantly less likely among patients older than 35 as compared with those younger than 25 (OR 0.19, 95% CI 0.08-0.49, P=0.003) and significantly more likely after surgical excision without closure versus deroofing procedures (OR 4.38, 95% CI 1.02-18.29, P=0.04). The likelihood of recurrence was unrelated to sex, race/ethnicity, BMI, surgical site, diabetes status, or use of TNF inhibitors.
With regard to patient satisfaction with the surgery, patients said they would have the surgery again and recommend it to a friend after 84% of the procedures, were glad they had the surgery in 86% of cases, and said the surgery met expectations 81% of the time. Besides being "extremely" or "very" satisfied with the surgery in 76% of cases, patients were satisfied with the appearance of the healed wound (58%) and recovery time (74%).
Factors associated with lower patient satisfaction included current smoking status (P<0.001), local excision without closure (P=0.02), inguinal or pubic surgical site (P=0.048), and recurrence (P=0.01).
Asked to rate intraoperative pain on a scale of 0 (none) to 10 (worst ever), patients reported no pain after 31% of the procedures and pain scores of 1 to 4 after 45%. During the first week of recovery, patients reported pain levels ≥8 after 32% of procedures but in 65% of cases, patients said the pain of an HS flare was worse than after the surgery.
Disclosures
The study was supported by the Carolina Medical Student Research Program and the NIH.
Sayed disclosed relationships with Incyte, AbbVie, Novartis, UCB, ChemoCentryx, and InflaRx.
Primary Source
JAMA Dermatology
Ravi S, et al "Patient impressions and outcomes after clinic-based hidradenitis suppurativa surgery" JAMA Dermatol 2022; DOI: 10.1001/jamadermatol.2021.4741.