Modifiable Factors Such as Nicotine Use, Obesity, Vitamin D Deficiency, Diabetes, and Hypertension Predict Acute Complications of Dermatologic Surgery

BACKGROUND: Postoperative complications from dermatologic surgeries lead to patient morbidity and increased health care costs. Identifying patient-specific risk factors may improve outcomes. OBJECTIVE: Evaluate risk factors for acute complications of excisional dermatologic surgery while controlling for confounding variables. MATERIALS AND METHODS: This retrospective cohort study used the TriNetX database, which included data from approximately 930,000 patients undergoing excisional dermatologic surgery (Mohs micrographic surgery, malignant excisions, benign excisions). Propensity scoring balanced cohorts on a wide range of conditions and medications. Logistic regressions evaluated patient characteristics and 30-day complication rates. RESULTS: The overall complication rate was low (1.7%). Nicotine use, obesity, anticoagulants (e.g., warfarin, apixaban, heparin), and antiplatelets (e.g., aspirin, clopidogrel, ticagrelor) predicted complications. Vitamin D deficiency and oral corticosteroid use predicted infection and dehiscence. Oral immunosuppressants (methotrexate, azathioprine, mycophenolate, cyclosporine, tacrolimus, sirolimus, and everolimus) showed no association with complications. Poorly controlled DM or HTN were associated with greater odds of complications relative to well-controlled diabetes and hypertension. CONCLUSION: Modifiable risk factors, including nicotine use, obesity, vitamin D deficiency, and poorly controlled diabetes or hypertension, predict complications. Considering these factors preoperatively and postoperatively could improve dermatologic surgery outcomes.