Surgical treatment of advanced hidradenitis suppurativa found safe, effective

In a large retrospective study of patients with hidradenitis suppurativa (HS) managed with surgical procedures, excision and unroofing methods were associated with low rates of complications, moderate levels of postoperative recurrences, and low rates of reoperations for those experiencing recurrences.

“Data from this surgical series of patients with HS demonstrate that surgical management is a safe and effective treatment for advanced intractable HS disease,” concluded John J. Kohorst, MD, a resident in dermatology at the Mayo Clinic, Rochester, Minn., and his associates (Dermatol Surg. 2016;42:1030-40).

Although a variety of surgical procedures have been described as treatments for advanced, intractable HS, the efficacy and safety of specific operative methodologies have remained unclear because of the relatively small number of patients examined in previous studies, they noted.

To further elucidate the efficacy and safety of currently available surgical treatment options for patient with advanced HS, they conducted a retrospective medical chart review of 590 consecutive patients with HS who underwent excision, unroofing, or drainage operative procedures between Jan. 1, 1976, and Dec. 31, 2012. This cohort included almost three times as many patients as the largest of the previously published studies on the subject. Their mean age at the time of surgery was 41 years, and most (80.7%) had Hurley stage III disease.

The majority of patients had undergone excision (68.6%) and unroofing (28.5%) procedures.

Most of the procedures were safe and effective, according to the investigators. Only 15 of the 590 patients (2.5%) experienced postoperative complications within the first 30 days of surgery (including 9 cases of cellulitis and 2 skin graft losses). Although 144 patients (24.4%) experienced recurrence at the surgical site, only 69 of the 590 patients (11.7%) required reoperation over an average of about 25 months.

The results of the multivariate Cox proportional hazards regression analysis, used to determine factors associated with risk of recurrence, indicated that surgery at multiple sites (hazard ratio, 1.6; 95% confidence interval, 1.1-2.5), and incision and drainage procedures (HR, 3.5; 95% CI, 1.2-10.7) were all significantly associated with higher rates of recurrence. In addition, “for each decade younger at the time of surgery, patients had a significantly increased recurrence risk,” they wrote.

In an interview, Dr. Kohorst said that there was a “significant effect of age on postoperative recurrence,” with patients under age 30 having approximately a 50% chance of recurrence, compared with a 25% chance of recurrence in patients older than 50 years of age.

Conversely, other variables they assessed including the specific surgical site(s) examined, disease severity based on the patient’s Hurley stage, gender, and the extent of the operation were not associated with an increase in recurrence rates. No difference was detected between the risk of recurrence for those undergoing excision or unroofing (HR, 1.0; 95% CI, 0.6-1.4).

Based on their overall findings, the authors concluded that “with well-planned, individualized surgical care, the likelihood of postoperative recurrence rests largely on patient age at surgical treatment and the number of surgical sites.”

They disclosed no conflicts of interest. A funding source of the study was not provided.

In a large retrospective study of patients with hidradenitis suppurativa (HS) managed with surgical procedures, excision and unroofing methods were associated with low rates of complications, moderate levels of postoperative recurrences, and low rates of reoperations for those experiencing recurrences.

“Data from this surgical series of patients with HS demonstrate that surgical management is a safe and effective treatment for advanced intractable HS disease,” concluded John J. Kohorst, MD, a resident in dermatology at the Mayo Clinic, Rochester, Minn., and his associates (Dermatol Surg. 2016;42:1030-40).

Although a variety of surgical procedures have been described as treatments for advanced, intractable HS, the efficacy and safety of specific operative methodologies have remained unclear because of the relatively small number of patients examined in previous studies, they noted.

To further elucidate the efficacy and safety of currently available surgical treatment options for patient with advanced HS, they conducted a retrospective medical chart review of 590 consecutive patients with HS who underwent excision, unroofing, or drainage operative procedures between Jan. 1, 1976, and Dec. 31, 2012. This cohort included almost three times as many patients as the largest of the previously published studies on the subject. Their mean age at the time of surgery was 41 years, and most (80.7%) had Hurley stage III disease.

The majority of patients had undergone excision (68.6%) and unroofing (28.5%) procedures.

Most of the procedures were safe and effective, according to the investigators. Only 15 of the 590 patients (2.5%) experienced postoperative complications within the first 30 days of surgery (including 9 cases of cellulitis and 2 skin graft losses). Although 144 patients (24.4%) experienced recurrence at the surgical site, only 69 of the 590 patients (11.7%) required reoperation over an average of about 25 months.

The results of the multivariate Cox proportional hazards regression analysis, used to determine factors associated with risk of recurrence, indicated that surgery at multiple sites (hazard ratio, 1.6; 95% confidence interval, 1.1-2.5), and incision and drainage procedures (HR, 3.5; 95% CI, 1.2-10.7) were all significantly associated with higher rates of recurrence. In addition, “for each decade younger at the time of surgery, patients had a significantly increased recurrence risk,” they wrote.

In an interview, Dr. Kohorst said that there was a “significant effect of age on postoperative recurrence,” with patients under age 30 having approximately a 50% chance of recurrence, compared with a 25% chance of recurrence in patients older than 50 years of age.

Conversely, other variables they assessed including the specific surgical site(s) examined, disease severity based on the patient’s Hurley stage, gender, and the extent of the operation were not associated with an increase in recurrence rates. No difference was detected between the risk of recurrence for those undergoing excision or unroofing (HR, 1.0; 95% CI, 0.6-1.4).

Based on their overall findings, the authors concluded that “with well-planned, individualized surgical care, the likelihood of postoperative recurrence rests largely on patient age at surgical treatment and the number of surgical sites.”

They disclosed no conflicts of interest. A funding source of the study was not provided.

In a large retrospective study of patients with hidradenitis suppurativa (HS) managed with surgical procedures, excision and unroofing methods were associated with low rates of complications, moderate levels of postoperative recurrences, and low rates of reoperations for those experiencing recurrences.

“Data from this surgical series of patients with HS demonstrate that surgical management is a safe and effective treatment for advanced intractable HS disease,” concluded John J. Kohorst, MD, a resident in dermatology at the Mayo Clinic, Rochester, Minn., and his associates (Dermatol Surg. 2016;42:1030-40).

Although a variety of surgical procedures have been described as treatments for advanced, intractable HS, the efficacy and safety of specific operative methodologies have remained unclear because of the relatively small number of patients examined in previous studies, they noted.

To further elucidate the efficacy and safety of currently available surgical treatment options for patient with advanced HS, they conducted a retrospective medical chart review of 590 consecutive patients with HS who underwent excision, unroofing, or drainage operative procedures between Jan. 1, 1976, and Dec. 31, 2012. This cohort included almost three times as many patients as the largest of the previously published studies on the subject. Their mean age at the time of surgery was 41 years, and most (80.7%) had Hurley stage III disease.

The majority of patients had undergone excision (68.6%) and unroofing (28.5%) procedures.

Most of the procedures were safe and effective, according to the investigators. Only 15 of the 590 patients (2.5%) experienced postoperative complications within the first 30 days of surgery (including 9 cases of cellulitis and 2 skin graft losses). Although 144 patients (24.4%) experienced recurrence at the surgical site, only 69 of the 590 patients (11.7%) required reoperation over an average of about 25 months.

The results of the multivariate Cox proportional hazards regression analysis, used to determine factors associated with risk of recurrence, indicated that surgery at multiple sites (hazard ratio, 1.6; 95% confidence interval, 1.1-2.5), and incision and drainage procedures (HR, 3.5; 95% CI, 1.2-10.7) were all significantly associated with higher rates of recurrence. In addition, “for each decade younger at the time of surgery, patients had a significantly increased recurrence risk,” they wrote.

In an interview, Dr. Kohorst said that there was a “significant effect of age on postoperative recurrence,” with patients under age 30 having approximately a 50% chance of recurrence, compared with a 25% chance of recurrence in patients older than 50 years of age.

Conversely, other variables they assessed including the specific surgical site(s) examined, disease severity based on the patient’s Hurley stage, gender, and the extent of the operation were not associated with an increase in recurrence rates. No difference was detected between the risk of recurrence for those undergoing excision or unroofing (HR, 1.0; 95% CI, 0.6-1.4).

Based on their overall findings, the authors concluded that “with well-planned, individualized surgical care, the likelihood of postoperative recurrence rests largely on patient age at surgical treatment and the number of surgical sites.”

They disclosed no conflicts of interest. A funding source of the study was not provided.