Surgical Management of Hidradenitis Suppurativa: Outcomes of 590 Consecutive Patients

John J. Kohorst, Christian Baum, Clark C. Otley, Randall K. Roenigk, Louis A. Schenck, John H. Pemberton, Eric Dozois, Nho V. Tran, Alex Senchenkov, Mark D.P. Davis

Research output: Contribution to journalReview article

22 Citations (Scopus)

Abstract

BACKGROUND Hidradenitis suppurativa is a progressive, recurrent inflammatory disease. Surgical management is potentially curative with limited efficacy data. OBJECTIVE To evaluate hidradenitis surgical patients. METHODS Retrospective review of outcomes of 590 consecutive surgically treated patients. RESULTS Most patients were white (91.0% [435/478]), men (337 [57.1%]), smokers (57.7% [297/515]) with Hurley Stage III disease (476 [80.7%]). Procedure types were excision (405 [68.6%]), unroofing (168 [28.5%]), and drainage (17 [2.9%]) treating disease of perianal/perineum (294 [49.8%]), axilla (124 [21.0%]), gluteal cleft (76 [12.9%]), inframammary (12 [2.0%]), and multiple surgical sites (84 [14.2%]). Postoperative complications occurred in 15 patients (2.5%) and one-fourth (144 [24.4%]) suffered postoperative recurrence, which necessitated reoperation in one-tenth (69 [11.7%]) of patients. Recurrence risk was increased by younger age (hazard ratio [HR], 0.8; 95% confidence interval [CI], 0.7-0.9),multiple surgical sites (HR, 1.6; 95% CI, 1.1-2.5), and drainage-type procedures (HR, 3.5; 95% CI, 1.2-10.7). Operative location, disease severity, gender, and operative extent did not influence recurrence rate. CONCLUSION Excision and unroofing procedures were effective treatments with infrequent complications and low recurrence rates. Well-planned surgical treatment aiming to remove or unroof the area of intractable hidradenitis suppurativa was highly effective in the management of this challenging disease.

Original languageEnglish (US)
Pages (from-to)1030-1040
Number of pages11
JournalDermatologic Surgery
Volume42
Issue number9
DOIs
StatePublished - Sep 1 2016

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Hidradenitis Suppurativa
Recurrence
Confidence Intervals
Drainage
Hidradenitis
Perineum
Axilla
Disease Management
Reoperation
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Dermatology

Cite this

Kohorst, J. J., Baum, C., Otley, C. C., Roenigk, R. K., Schenck, L. A., Pemberton, J. H., ... Davis, M. D. P. (2016). Surgical Management of Hidradenitis Suppurativa: Outcomes of 590 Consecutive Patients. Dermatologic Surgery, 42(9), 1030-1040. https://doi.org/10.1097/DSS.0000000000000806

Surgical Management of Hidradenitis Suppurativa : Outcomes of 590 Consecutive Patients. / Kohorst, John J.; Baum, Christian; Otley, Clark C.; Roenigk, Randall K.; Schenck, Louis A.; Pemberton, John H.; Dozois, Eric; Tran, Nho V.; Senchenkov, Alex; Davis, Mark D.P.

In: Dermatologic Surgery, Vol. 42, No. 9, 01.09.2016, p. 1030-1040.

Research output: Contribution to journalReview article

Kohorst, JJ, Baum, C, Otley, CC, Roenigk, RK, Schenck, LA, Pemberton, JH, Dozois, E, Tran, NV, Senchenkov, A & Davis, MDP 2016, 'Surgical Management of Hidradenitis Suppurativa: Outcomes of 590 Consecutive Patients', Dermatologic Surgery, vol. 42, no. 9, pp. 1030-1040. https://doi.org/10.1097/DSS.0000000000000806
Kohorst, John J. ; Baum, Christian ; Otley, Clark C. ; Roenigk, Randall K. ; Schenck, Louis A. ; Pemberton, John H. ; Dozois, Eric ; Tran, Nho V. ; Senchenkov, Alex ; Davis, Mark D.P. / Surgical Management of Hidradenitis Suppurativa : Outcomes of 590 Consecutive Patients. In: Dermatologic Surgery. 2016 ; Vol. 42, No. 9. pp. 1030-1040.
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abstract = "BACKGROUND Hidradenitis suppurativa is a progressive, recurrent inflammatory disease. Surgical management is potentially curative with limited efficacy data. OBJECTIVE To evaluate hidradenitis surgical patients. METHODS Retrospective review of outcomes of 590 consecutive surgically treated patients. RESULTS Most patients were white (91.0{\%} [435/478]), men (337 [57.1{\%}]), smokers (57.7{\%} [297/515]) with Hurley Stage III disease (476 [80.7{\%}]). Procedure types were excision (405 [68.6{\%}]), unroofing (168 [28.5{\%}]), and drainage (17 [2.9{\%}]) treating disease of perianal/perineum (294 [49.8{\%}]), axilla (124 [21.0{\%}]), gluteal cleft (76 [12.9{\%}]), inframammary (12 [2.0{\%}]), and multiple surgical sites (84 [14.2{\%}]). Postoperative complications occurred in 15 patients (2.5{\%}) and one-fourth (144 [24.4{\%}]) suffered postoperative recurrence, which necessitated reoperation in one-tenth (69 [11.7{\%}]) of patients. Recurrence risk was increased by younger age (hazard ratio [HR], 0.8; 95{\%} confidence interval [CI], 0.7-0.9),multiple surgical sites (HR, 1.6; 95{\%} CI, 1.1-2.5), and drainage-type procedures (HR, 3.5; 95{\%} CI, 1.2-10.7). Operative location, disease severity, gender, and operative extent did not influence recurrence rate. CONCLUSION Excision and unroofing procedures were effective treatments with infrequent complications and low recurrence rates. Well-planned surgical treatment aiming to remove or unroof the area of intractable hidradenitis suppurativa was highly effective in the management of this challenging disease.",
author = "Kohorst, {John J.} and Christian Baum and Otley, {Clark C.} and Roenigk, {Randall K.} and Schenck, {Louis A.} and Pemberton, {John H.} and Eric Dozois and Tran, {Nho V.} and Alex Senchenkov and Davis, {Mark D.P.}",
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AU - Kohorst, John J.

AU - Baum, Christian

AU - Otley, Clark C.

AU - Roenigk, Randall K.

AU - Schenck, Louis A.

AU - Pemberton, John H.

AU - Dozois, Eric

AU - Tran, Nho V.

AU - Senchenkov, Alex

AU - Davis, Mark D.P.

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N2 - BACKGROUND Hidradenitis suppurativa is a progressive, recurrent inflammatory disease. Surgical management is potentially curative with limited efficacy data. OBJECTIVE To evaluate hidradenitis surgical patients. METHODS Retrospective review of outcomes of 590 consecutive surgically treated patients. RESULTS Most patients were white (91.0% [435/478]), men (337 [57.1%]), smokers (57.7% [297/515]) with Hurley Stage III disease (476 [80.7%]). Procedure types were excision (405 [68.6%]), unroofing (168 [28.5%]), and drainage (17 [2.9%]) treating disease of perianal/perineum (294 [49.8%]), axilla (124 [21.0%]), gluteal cleft (76 [12.9%]), inframammary (12 [2.0%]), and multiple surgical sites (84 [14.2%]). Postoperative complications occurred in 15 patients (2.5%) and one-fourth (144 [24.4%]) suffered postoperative recurrence, which necessitated reoperation in one-tenth (69 [11.7%]) of patients. Recurrence risk was increased by younger age (hazard ratio [HR], 0.8; 95% confidence interval [CI], 0.7-0.9),multiple surgical sites (HR, 1.6; 95% CI, 1.1-2.5), and drainage-type procedures (HR, 3.5; 95% CI, 1.2-10.7). Operative location, disease severity, gender, and operative extent did not influence recurrence rate. CONCLUSION Excision and unroofing procedures were effective treatments with infrequent complications and low recurrence rates. Well-planned surgical treatment aiming to remove or unroof the area of intractable hidradenitis suppurativa was highly effective in the management of this challenging disease.

AB - BACKGROUND Hidradenitis suppurativa is a progressive, recurrent inflammatory disease. Surgical management is potentially curative with limited efficacy data. OBJECTIVE To evaluate hidradenitis surgical patients. METHODS Retrospective review of outcomes of 590 consecutive surgically treated patients. RESULTS Most patients were white (91.0% [435/478]), men (337 [57.1%]), smokers (57.7% [297/515]) with Hurley Stage III disease (476 [80.7%]). Procedure types were excision (405 [68.6%]), unroofing (168 [28.5%]), and drainage (17 [2.9%]) treating disease of perianal/perineum (294 [49.8%]), axilla (124 [21.0%]), gluteal cleft (76 [12.9%]), inframammary (12 [2.0%]), and multiple surgical sites (84 [14.2%]). Postoperative complications occurred in 15 patients (2.5%) and one-fourth (144 [24.4%]) suffered postoperative recurrence, which necessitated reoperation in one-tenth (69 [11.7%]) of patients. Recurrence risk was increased by younger age (hazard ratio [HR], 0.8; 95% confidence interval [CI], 0.7-0.9),multiple surgical sites (HR, 1.6; 95% CI, 1.1-2.5), and drainage-type procedures (HR, 3.5; 95% CI, 1.2-10.7). Operative location, disease severity, gender, and operative extent did not influence recurrence rate. CONCLUSION Excision and unroofing procedures were effective treatments with infrequent complications and low recurrence rates. Well-planned surgical treatment aiming to remove or unroof the area of intractable hidradenitis suppurativa was highly effective in the management of this challenging disease.

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