HIDRADENITIS suppurativa (HS) is a chronic inflammatory skin condition that often necessitates surgical intervention. However, the influence of common comorbidities such as obesity, diabetes, and smoking on post-surgical outcomes remains insufficiently explored. A systematic review of existing studies provides insight into these associations and highlights the need for further research.
A total of 12 studies met the final inclusion criteria, each assessing complication rates in patients with at least one of the aforementioned comorbidities. Of these, 10 studies examined obesity, with 3 finding a significant association between obesity and post-surgical complications. One study noted an increased risk of wound dehiscence and hospital readmission in cases involving flap reconstruction, debridement, and skin-grafting techniques. Another study found an association between obesity and wound dehiscence, while a third linked obesity to delayed wound healing.
Diabetes was investigated in 5 studies, with only one demonstrating a correlation between the condition and higher hospital readmission rates. Specifically, patients with diabetes undergoing debridement (deroofing or excision without flap/graft) and flap reconstruction had an increased risk of post-surgical complications.
Interestingly, none of the studies evaluating smoking identified an increased risk of complications. This contrasts with broader surgical literature, where smoking is commonly associated with impaired healing and higher complication rates.
These findings underscore the necessity for more consistent and rigorous analysis of surgical outcomes in patients with HS and comorbidities. The limited data available suggests a potential impact of obesity and diabetes on post-surgical recovery, but more high-quality clinical trials are needed to confirm these trends. Improving access to surgery and optimising preoperative management strategies for patients with HS will be crucial in enhancing outcomes and reducing complication rates in this population.
Katie Wright, EMJ
Reference
Shams RB, Sayed CJ. Hidradenitis suppurativa surgery complication rates among patients with obesity or diabetes or who smoke: a review. JAMA Dermatol. 2025;DOI:10.1001/jamadermatol.2024.5731.
