LAUSR

Objective Hidradenitis suppurativa (HS) is a painful inflammatory skin disease. Management is largely medical, with surgery reserved for severe refractory cases. In this study we conduct a retrospective analysis of a multi-institutional database to investigate the surgical management of patients with HS and identify trends in the postoperative outcomes. Approach The 2011-2019 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database was reviewed to identify patients who underwent surgery for management of HS. Post-operative outcomes were assessed including surgical and medical complications, length of hospital stay, reoperation, re-admission, and non-home discharge. This manuscript was reported according to the STROBE criteria. Results We identified 1030 patients, of which 62% were female and 50% were Black. The most common co-morbidity was obesity (61%). Surgery was mainly performed by general surgeons (62%) and plastic surgeons (31%). Complications were overall low, with readmission being the most common (7.1%, unplanned 6.0%), followed by re-operation (5.8%). The most common surgical complication was superficial incisional infection (5.1%) and most common medical complication was sepsis (3.8%). Obesity is seen to affect surgical complication rates, with patients with obesity having higher rates of dehiscence (Obese: 3.1% and Non-obese: 1.0%; p = 0.03) but lower rates of organ space infection (Obese: 0.5% and Non-obese: 2.0%; p = 0.03) and transfusion (Obese: 2.5% and Non-obese: 5.2%; p = 0.04). A focus on complications in patients undergoing flap reconstruction (n= 293; 23%), identified higher rates of surgical complications, with superficial incisional infection being the most common (Flap reconstruction: 7.5% and I&D, Debridement, Skin graft: 4.1%; p = 0.04). Innovation The surgical management of HS is analyzed at the national level, with post-operative complications seen to depend on race and obesity-status. Conclusions Surgical management for HS is associated with low post-operative complications, making surgery a viable treatment option for this disease.