Surgical Safety
Surgical Site Infection Rates Following Mohs Micrographic Surgery: A Comprehensive Analysis of 7,769 Consecutive Procedures in an AAAHC-Accredited Ambulatory Surgical Center
Abstract
Background: Surgical site infection (SSI) remains the most significant complication following dermatologic surgery, with reported rates varying widely in the literature. Limited data exist on infection rates stratified by anatomic location and repair complexity in high-volume Mohs surgery practices.
Objective: To comprehensively analyze SSI rates across different anatomic regions and repair complexities in a large, single-surgeon series and compare outcomes to published benchmarks.
Methods: A retrospective analysis of prospectively maintained surgical data from January 1, 2021, to November 15, 2023, was conducted. All procedures were performed by a single fellowship-trained Mohs surgeon in an AAAHC-accredited ambulatory surgical center. Cases referred for external repair or with deferred reconstruction were excluded. The primary outcome was culture-confirmed SSI rate. Secondary analyses included stratification by anatomic region, repair complexity, and temporal trends.
Results: Of 7,769 analyzed procedures, 32 surgical site infections occurred (0.41%, 95% CI:0.27-0.55%). This rate was significantly lower than published benchmarks ranging from 1.6-2.5% (p<0.0001). Despite 43.6% of cases requiring complex flap or graft reconstruction, infection rates remained low across all repair types. Extremity locations demonstrated the highest infection rates (upper extremity: 1.02%, lower extremity: 1.15%), while head and neck sites showed exceptionally low rates (nose: 0.23%, ear: 0.12%). A significant decreasing trend in infection rates was observed over the study period (2021:0.53% → 2023:0.18%, p<0.05).
Conclusion: This large single-surgeon series demonstrates substantially lower SSI rates compared to published literature across all anatomic regions and repair complexities. These findings validate the efficacy of standardized protocols within an accredited surgical environment and provide robust benchmarks for quality improvement initiatives in dermatologic surgery.
Keywords: Mohs micrographic surgery, surgical site infection, dermatologic surgery, quality improvement, ambulatory surgery center.
