Title : Optimising outpatient dermatologic surgery: Evidence-based strategies for safety and scalability
Abstract:
Introduction: Outpatient dermatologic surgery has evolved from minor interventions to complex procedures, driven by technical advancements and healthcare system shifts. This transition demands rigorous protocols to ensure safety and efficiency, particularly in high-risk patients. Our research addresses bleeding risk, infection control, and surgical technique adaptation to optimise ambulatory care.
Materials and Methods: We conducted a multi-method research portfolio comprising:
- A meta-analysis of >9,000 dermatologic surgeries comparing inpatient vs. outpatient bleeding rates.
- A prospective trial of bilateral tumour excisions using modified haemostatic protocols.
- Retrospective analysis of infection incidence across 3,240 outpatient procedures.
Standardised interventions included bipolar coagulation, multilayer intradermal suturing, and structured follow-up schedules.
Results: Meta-analysis revealed a pooled postoperative bleeding rate of 0.3% in outpatient cases vs. 2.5% inpatient. Anticoagulated patients had a 2.6-fold increased bleeding risk, yet most events were mild. In the prospective trial (n=50), modified protocols reduced bleeding from 12% to 0% compared to historical controls. Infection rates remained low: 0% in biopsies, 1.36% in simple excisions, and 1.5% in two-stage reconstructions. No systemic infections or hospitalisations occurred.
Conclusion: Outpatient dermatologic surgery is safe and scalable when structured protocols are applied. Key measures include continuing anticoagulants, using bipolar coagulation, multilayer suturing, and enforcing asepsis training. These strategies enable treatment of complex cases outside hospital settings without compromising outcomes, supporting cost-effective and patient-centred care.
