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Examining the Relevance to Patients of Complications in the American College of Mohs Surgery Registry

Results of a Delphi Consensus Process

Etzkorn, Jeremy R., MD*; Gharavi, Nima M., MD, PhD†,‡; Carr, David R., MD§; Tope, Whitney D., MPhil, MD; Bordeaux, Jeremy S., MD, MPH; Maher, Ian A., MD#

doi: 10.1097/DSS.0000000000001456
Original Article

BACKGROUND Surgical registries are valuable tools for tracking outcomes. Incorporating patient input allows registries to address the interests of this important stakeholder group.

OBJECTIVE The aim of this study was to identify a list of “patient-selected complications” and to explore the relevance to patients of previously published physician-identified complications.

METHODS Delphi process with 2 rounds using patients to identify complications that are highly relevant for tracking by the proposed American College of Mohs Surgery (ACMS) National Registry.

RESULTS Complications that physicians identified as highly relevant (death from any cause, hospitalization related to the procedure, functional loss attributable to surgery, bleeding requiring a second procedure, and surgical site infection) were each rated as highly relevant by patients. Patients also identified scarring, recurrence, and wound dehiscence as highly relevant outcomes for registry tracking.

CONCLUSION Incorporating patient input into the ACMS registry design process identified 2 additional complication outcomes to be considered for inclusion within the registry—wound dehiscence and scarring. Patient input also corroborated the relevance of complications previously identified by ACMS physicians for inclusion in the registry. Furthermore, the importance of tracking local recurrence was confirmed from a patient-centered perspective.

*Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania;

Department of Dermatology, Cedars-Sinai Medical Group, Beverly Hills, California;

Division of Dermatology, Department of Medicine, University of California, Los Angeles, California;

§Division of Dermatology, The Ohio State University, Columbus, Ohio;

Academic Dermatology, PC, Edina, Minnesota;

Department of Dermatology, Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, Ohio;

#Department of Dermatology, St. Louis University, St. Louis, Missouri

Address correspondence and reprint requests to: Jeremy R. Etzkorn, MD, Mohs and Reconstructive Surgery, Division of Dermatologic Surgery, University of Pennsylvania Health System, 3400 Civic Center Boulevard, Philadelphia, PA 19104, or e-mail:

J.R. Etzkorn is supported by a Dermatology Foundation Clinical Career Development Award in Dermatologic Surgery.

The authors have indicated no significant interest with commercial supporters.

This study was approved by the institutional review board of St. Louis University.

© 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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