Looking beyond the scalpel: Assessing patient risk factors for complications following surgical excision of hidradenitis suppurativa.

Abstract

Hidradenitis suppurativa (HS) is a chronic inflammatory disease affecting intertriginous skin. Severe HS presents a reconstructive challenge due to high complication rates; however, risk factors for complications are understudied. This study examines patient-level risk factors for increased complications and operative techniques used at our institution. We conducted an IRB-approved retrospective review of patients (≥18 years) who underwent primary or secondary wide local excision of HS between 12/1/2015-06/02/2022. Sociodemographic, intraoperative, and complication data were analyzed using descriptive statistics and Fisher's exact tests. Multiple logistic regression was used to determine the association between patient demographic factors and occurrence of any complications. Significance was set at p < 0.05. Of the 347 patients identified, 239 met inclusion criteria (median age 35 years, follow-up time 13 months). Most patients were Black (76 %) and non-Hispanic/non-Latino (95 %). Common HS risk factors included current smoking (20 %), former smoking (18 %), and diabetes (15 %). Patients were classified as Hurley Stage I (6 %), II (23 %), and III (45 %). Overall, 284 complications were reported, with more severe complications (e.g., flap/graft failure, hypertrophic granulation, keloid formation, hypertrophic scarring) predominantly occurring in Stage III. Complication rates of "other" complications differed significantly across Hurley stages I, II, and III (7 %, 2 %, 21 %, respectively; p < 0.01), with Stage III having the highest rates. Unplanned reoperations also demonstrated significant differences across stages (27 %, 4 %, 18 %, respectively; p = 0.01). Regression analysis showed White race was significantly associated with lower complication risk (p = 0.039), while prior immunomodulator use increased risk (p = 0.02). Disease severity and demographic factors significantly impact HS surgical outcomes. Patients in Hurley Stage III experienced higher complication rates. White race was associated with decreased complication risk while prior immunomodulator use was associated with increased complication risk, suggesting sociodemographic disparities and disease complexity contribute to poorer post-operative outcomes.