Surgical outcomes of hidradenitis suppurativa: evaluating factors influencing recurrence and complications after 284 complete excisions

Abstract

Abstract Background Hidradenitis suppurativa (HS) is a chronic inflammatory disorder associated with tunnel formation and scarring. Surgical excision is a potential curative therapy for HS. Objectives To characterize the surgical outcomes of patients with HS undergoing complete excision and to identify the risk factors associated with postoperative recurrence. Methods This retrospective 16-year cohort study enrolled patients 20 years or older who underwent complete excision for HS lesions at the National Taiwan University Hospital. We assessed the rates of postsurgical recurrence and complications, and estimated the odds ratio (ORs) with 95% confidence intervals (CIs) of their association with potential risk factors using generalized estimating equations. Results In total, 136 patients with HS and the 284 corresponding complete excisions were identified. Recurrence developed in 88 (31.0%) operations, while complications occurred in 102 (35.9%). Common types of complications included wound dehiscence, hypertrophic scars, and surgical site infection. Clinical factors associated with a lower risk of recurrence were male sex (aOR, 0.48; 95% CI, 0.23–0.98), operation at atypical locations (aOR, 0.28; 95% CI, 0.08–0.99), and wound repair by split-thickness skin graft (aOR, 0.31; 95% CI, 0.12–0.77). Wound dehiscence was associated with an increased risk of recurrence (aOR, 2.55; 95% CI, 1.21–5.42). No independent factors were identified as being associated with composite postoperative complications. Conclusions Complete excision alone is effective in curing HS in Asians. Recurrence developed in about one-third of the complete excisions performed for HS. Sex, operative locations, methods of wound repair, and wound dehiscence were major determinants for recurrence.