Shorter Wound-healing Times Associated With Select Perioperative Medical Therapies in Hidradenitis Suppurativa Surgery, and a Limited Clinical Role of Intraoperative Cultures

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of apocrine gland-bearing areas characterized by abscesses, tunneling, scarring, and recurrent flares. Surgical excision is central in refractory disease, but perioperative protocols are variable. We evaluated whether specific perioperative medical therapies are associated with shorter time to documented postoperative wound-healing progress after HS surgery, and whether intraoperative cultures meaningfully guide antibiotic management. METHODS: We conducted a retrospective cohort study of 194 HS surgeries performed at a quaternary care center between January 1, 2013, and July 1, 2021. We abstracted perioperative medical therapies (including antibiotics and spironolactone), intraoperative culture results, postoperative antibiotics, and healing times from the medical record. Healing was defined as days from surgery to the first follow-up note documenting substantial wound-healing progress. Time to healing was analyzed with Kaplan-Meier survival curves and Cox proportional hazards models. We also examined whether intraoperative cultures were associated with postoperative antibiotic selection. RESULTS: Perioperative trimethoprim-sulfamethoxazole was associated with shorter time to documented healing [hazard ratio (HR) 2.55, 95% CI: 1.46-4.46, P=0.00099]. Preoperative cephalexin was also associated with shorter time to heal (HR: 4.17, 95% CI: 1.40-12.44, P=0.01), whereas postoperative cephalexin was not (HR: 0.89, 95% CI: 0.44-1.79, P=0.74). Perioperative spironolactone was associated with faster healing (HR: 5.72, 95% CI: 2.08-15.74, P=0.00073). Intraoperative cultures were collected in 28% of surgeries, yielded gram-positive, gram-negative, and anaerobic organisms, showed only weak, nonsignificant associations with preoperative antibiotic exposure, and were not significantly associated with postoperative antibiotic choice. CONCLUSIONS: Perioperative trimethoprim-sulfamethoxazole, cephalexin, and spironolactone were each associated with shorter time to documented wound-healing progress after HS surgery in this retrospective cohort. Routine intraoperative cultures demonstrated limited observed clinical utility in guiding immediate postsurgical antibiotics. These findings support efforts to streamline perioperative care while de-emphasizing routine intraoperative culture collection in HS surgery.