Prospective study of skin surgery in patients with and without known diabetes

Dermatol Surg. 2009 Jul;35(7):1035-40. doi: 10.1111/j.1524-4725.2009.01180.x. Epub 2009 May 8.


Objective: To study the association between known diabetes and complications after skin surgery.

Method: In a 5-year prospective observational study, 7,224 lesions were excised on 4,197 patients in a referral center involving one surgeon in a southern Australian locale.

Results: One hundred ninety-six patients with known diabetes (4.7%) underwent 551 excision procedures (7.6%) 4,001 people without diabetes underwent 6,673 procedures. Patients with diabetes were older (72 +/- 13) than those without (64 +/- 17) (p<.001.) Infection incidence was significantly higher in patients with diabetes (4.2%, 23/551) than in those without (2.0%, 135/6,673) (p<.001). There were five bleeds in patients with diabetes (0.9%) versus 47 in those without (0.7%) (p=.58). The incidence of wound dehiscence in patients with diabetes (2) was not different from that in those without (22), (p=.90). Noninfective complications were 1.8% for patients both with diabetes (10/551) and those without (118/6,673). Two thousand three hundred seventy-one flaps resulted in 14 (0.6%) cases of end-flap necrosis, but no case occurred in patients with diabetes. Multivariate analysis using binary logistic regression demonstrated that known diabetes was predictive of infection (odds ratio=1.66, 95% confidence interval=1.05-2.65). Diabetes was not predictive of other complications.

Conclusion: Patients with known diabetes suffer more postoperative skin infections than those without. Noninfective complications are similar. Clinicians may consider antibiotic prophylaxis in their patients with diabetes facing high-risk skin surgery.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Dermatologic Surgical Procedures*
  • Diabetes Complications / complications*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postoperative Complications
  • Prospective Studies
  • Skin Diseases / complications
  • Skin Diseases / surgery*