Increased Risk of Postoperative Complications in Patients with Hypertension Undergoing Mohs Micrographic Surgery

Hypertension has been previously associated with higher intraoperative bleeding risk in patients undergoing Mohs micrographic surgery. However, the risks of common postoperative Mohs micrographic surgery complications have not been substantiated by large studies. Our study aimed to assess the risks of common Mohs micrographic surgery complications for patients with hypertension utilizing the TriNetX database, a global health records database encompassing over 105 million patients' data, from January 2009 to January 2024. After 1:1 propensity score matching for age, sex, race, diabetes, nicotine dependence, obesity, and anticoagulant use, the final analysis included 80,739 patients in each cohort of patients with hypertension and matched controls. We found that within a 60-day postoperative period, patients with hypertension had a significantly higher risk of bleeding both intraoperatively (OR = 2.19, 95% confidence interval = 1.39-3.46) and postoperatively (OR = 2.11, 95% confidence interval = 1.44-3.09). In addition, patients with hypertension faced a significantly higher risk of various postoperative infections such as gangrene (OR = 2.17, 95% confidence interval = 1.24-3.79) and impaired wound healing (OR = 1.25, 95% confidence interval = 1.06-1.48). Results did not vary significantly by stage of hypertension. Essential hypertension is associated with significantly increased intraoperative and postoperative hemorrhage, infections, and wound disruptions; thus, it may be beneficial to assess and risk stratify patients with hypertension before performing Mohs micrographic surgery.