Hidradenitis Suppurativa: A Comparison of Institutional Experience with the Tracking Outcomes in Plastic Surgery (TOPS) Registry
Nathan Miller, MD, Sean Wallace, MD, Andrew Steele, MD, Yee-Cheng Low, MD, Robert X. Murphy, Jr., MD.
Lehigh Valley Health Network, Allentown, PA, USA.
Background: Hidradenitis Suppurativa (HS) is a highly morbid disease. Surgical treatment is fraught with complications. As a Divisional Quality Improvement initiative, we evaluated our experience and compared it to the Tracking Outcomes in Plastic Surgery (TOPS) registry. The purpose of this study was to provide insight into best practice for the surgical treatment of HS and gain insight whether TOPS truly reflects the experience of practicing Plastic Surgeons.
Methods: A retrospective chart review of surgically treated HS was performed from January 2004 to January 2016 using ICD-9 code 705.83. Data collected included patient demographics, reconstructive method, and complication rates. Reconstructive procedures included simple, intermediate, or complex closure and adjacent soft tissue rearrangement. Overall complication rates were reported as a percentage. A Fisher's Exact test was used to demonstrate associations between reconstruction and complications. These results were compared to TOPS.
Results: 383 operative sites in 101 patients were reviewed. Complication rates were: simple closure 80%, intermediate closure 68.3%, complex closure 59.6% and adjacent tissue rearrangement 69.5%, Regional complication rates were evaluated and compared against TOPS and is reported as LVHN/TOPS. Complex closure for the axilla 50%/31.9% for the inguinal region 25%/38.7% and perineum 50%/56.5%. There was no statistical difference between complication rate and type of reconstruction. Statistical significance was identified between superficial wound dehiscence and adjacent soft tissue rearrangement having the highest occurrence (p=0.0132). TOPS data indicated much lower complication rates were incurred when wounds were closed using Vacuum Assisted Closure (VAC), Split Thickness Skin Grafts (STSG) or Muscle Flaps (MF).
Conclusion: This study demonstrates the complicated nature of the surgical treatment of HS. The inguinal region has the highest overall complication rate (78.6%) with simple closure having the highest complication rate (80%), followed by adjacent soft tissue rearrangement (69.4%). Statistical significance was identified between superficial wound dehiscence and type of reconstruction. When comparing our institutional data to the national TOPS database, we identified modest discrepancies in absolute percentage but very similar trends in complications between similar closure methods. However, TOPS demonstrated lower complication rates with VAC, STSG and MF. This study has caused us to reevaluate our surgical approach to HS. It also supports the presumption that TOPS accurately reflects complications experienced by board certified plastic surgeons.
| Location | Closure Method | TOPS Wound Breakdown Complication Rate (50%) | Institutional Wound Breakdown Complication Rate (%) |
| Axillary | Complex | 31.9 | 50 |
| Inguinal | Complex | 38.7 | 25 |
| Perineal | Complex | 56.5 | 50 |
| Any | Split Thickness Skin Graft | 6.1 Inguinal | 100 |
| 11.1 Axillary | |||
| Any | Adjacent Tissue Transfer | 53.8 | 66.7 |
| Any | Negative Pressure Wound Therapy (VAC) | 12.5 | N/A |
Table 1. Comparison Data of Institutional Review versus TOP Database for Complication Rates.
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