Surgical outcomes of hidradenitis suppurativa: evaluating factors influencing recurrence and complications after 284 complete excisions

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disorder associated with tunnel formation and scarring. Surgical excision is a potential curative therapy for HS. OBJECTIVES: To characterize the surgical outcomes of patients with HS undergoing complete excision and to identify the risk factors associated with postoperative recurrence. METHODS: This retrospective 16-year cohort study enrolled patients ≥ 20 years who underwent complete excision for HS lesions at the National Taiwan University Hospital. We assessed the rates of postsurgical recurrence and complications and estimated the odds ratio (ORs) with 95% confidence intervals (CIs) of their association with potential risk factors using generalized estimating equations. RESULTS: In total, 136 patients with HS and the 284 corresponding complete excisions were identified. Recurrence developed in 88 of 284 (31.0%) operations and complications occurred in 102 (35.9%). Common types of complications included wound dehiscence, hypertrophic scars and surgical-site infection. Clinical factors associated with a lower risk of recurrence were male sex [adjusted OR (aOR) 0.48, 95% CI 0.23-0.98], surgery at atypical body sites (aOR 0.28, 95% CI 0.08-0.99) and wound repair by split-thickness skin graft (aOR 0.31, 95% CI 0.12-0.77). Wound dehiscence was associated with an increased risk of recurrence (aOR 2.55, 95% CI 1.21-5.42). No independent factors were identified as being associated with composite postoperative complications. CONCLUSIONS: Complete excision alone can be effective in curing HS in Asian populations. Recurrence developed in about one-third of the complete excisions performed for HS. Sex, surgical body sites, methods of wound repair and wound dehiscence were major determinants for recurrence.