Dermatologic surgery
Identifying and defining complications of dermatologic surgery to be tracked in the American College of Mohs Surgery (ACMS) Registry

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Background

In recent years, increasing emphasis has been placed on value-based health care delivery. Dermatology must develop performance measures to judge the quality of services provided. The implementation of a national complication registry is one such method of tracking surgical outcomes and monitoring the safety of the specialty.

Objective

The purpose of this study was to define critical outcome measures to be included in the complications registry of the American College of Mohs Surgery (ACMS).

Methods

A Delphi process was used to reach consensus on the complications to be recorded.

Results

Four major and one minor complications were selected: death, bleeding requiring additional intervention, functional loss attributable to surgery, hospitalization for an operative complication, and surgical site infection.

Limitations

This article addresses only one aspect of registry development: identifying and defining surgical complications.

Conclusion

The ACMS Registry aims to gather data to monitor the safety and value of dermatologic surgery. Determining and defining the outcomes to be included in the registry is an important foundation toward this endeavor.

Section snippets

Methods

An ACMS National Registry and Outcomes Committee (Table I) was appointed by the ACMS Board of Directors for their recognized expertise as Mohs surgeons. Members of the complication subcommittee were pulled from within the National Registry and Outcomes Committee and membership at large (Table II). Members of the committee were chosen to be representative of the ACMS membership, with private and university physicians, and fellow trainees. The complications subcommittee designed a Delphi process

Results

Sixteen committee members responded with free-text entries. The condensed list can be seen in Table III. Two major and one minor complications were rated as highly relevant after the first round of the Delphi process; 2 major and 8 minor complications were rated as low relevance and excluded from further consideration. Thirteen committee members responded to the second rating round. Two further major and one additional minor complications were rated as highly relevant and recommended for

Discussion

Improving the quality and value of patient care is of utmost importance in the current health care environment, and patient registries are a key component of this effort. National surgical registries have emerged as a valuable resource for assuring patient safety by accurately tracking complications and allowing for the comparison of complication rates among specialties and providers.

Although major complications, such as death and hospitalization, are rare occurrences in dermatologic surgery,19

References (27)

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Funding sources: None.

Conflicts of interest: None declared.

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