A retrospective cohort study showed that clinic-based surgery for hidradenitis suppurativa (HS) had high patient satisfaction despite frequent recurrences.
Patients said they were highly satisfied with the results of the deroofing surgery and tissue excision procedures three-quarters of the time. This surgery was associated with a median time to return to work or school, 2 days to resume normal activities, and 30 days to complete healing.
After about two-thirds of the procedures, patients said the pain of an HS flare was worse than pain during the postoperative period and recovery, reported Christopher Syed, MD, of the University of North Carolina at Chapel Hill, and co-authors. JAMA Dermatology,
“In our experience, recurrence often results in more temporary or limited disease activity than disease that occurred before surgery, leading to an overall benefit,” the investigators said. “In the present study, recurrence alone does not appear to be a marker of treatment failure, given that satisfaction remains high.”
in one audio interview Along with the article, Syed said that many HS patients are apprehensive about the surgery. Also, patients who may benefit from surgery are often “turned away.” With this in mind, the investigators sought to address three key patient-centered issues: how long to return to work or school, how long to return to normal activities, and how long it takes for wounds to heal.
“I wanted to be able to give him answers that framed the issue in a way that I could discuss it with him,” Syed said.
“These patients are used to wound care – this is normal care for them – and if you give them a chance for the wound to fully heal after 4 to 6 weeks, unlike a wound that never heals. Doesn’t happen, it’s a big upgrade for them… instead of having to deal with a permanent wound, wound care and pain every day,” he said.
Data for the retrospective analysis came from 194 surgical procedures in 78 patients in the same clinic from April 2014 to December 2018. The median age of the study population was 35, and 83% of patients were female. More than 80% of the procedures involved patients who were overweight or obese as defined by body mass index (BMI). The 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, also suggestive of advanced disease, at the time of surgery.
Two-thirds of surgeries were deroofing procedures, 27% involved local excision with close, and 6% had local excision without closure. The site of surgery was the axilla in one third of the procedures and the inguinal or pubic region in a fourth.
The primary outcomes were patient-reported recurrence, satisfaction with surgery, and pain. On average, patients completed the postoperative survey 13 months after surgery.
The results showed 79 repetitions (41% of the procedures). Patients older than 35 were significantly less likely to have recurrence than patients younger than 25 (OR 0.19, 95% CI 0.08–0.49, P= 0.003) with and without closure versus deroofing procedures (OR 4.38, 95% CI 1.02–18.29, P=0.04). The likelihood of recurrence was not related to sex, race/ethnicity, BMI, surgical site, diabetic status, or use of TNF inhibitors.
With regard to patient satisfaction with the surgery, patients said they would re-surgery and would recommend it to a friend after 84% of the procedures, were happy that they had surgery in 86% of cases, and said that the surgery was up to expectations. Fitted 81% of the time. In addition to being “extremely” or “very” satisfied with surgery in 76% of cases, patients were satisfied with the wound healed (58%) and the time it took to heal (74%).
Factors associated with low patient satisfaction include current smoking status (P<0.001), local excision without closure (P= 0.02), inguinal or pubic surgical site (P=0.048), and iteration (P= 0.01).
Asked to rate intraoperative pain on a scale of 0 (none) to 10 (worst), patients reported no pain after 31% of the procedures and a pain score of 1 to 4 after 45%. During the first week of recovery, patients reported pain levels 8 after 32% of the procedures, but in 65% of cases, patients said the pain of an HS flare was worse than after surgery.
The study was supported by the Carolina Medical Student Research Program and the NIH.
Syed disclosed ties with Incyte, AbbVie, Novartis, UCB, Chemocentrix and InflaRX.