Researchers studied nearly 930,000 patients who had skin surgery to understand what health conditions make complications more likely. They found that smoking, being overweight, low vitamin D levels, and poorly controlled diabetes or high blood pressure all increased the chance of problems after surgery. The good news? These are all things you can potentially improve before having surgery. The study suggests that doctors should check these specific health factors before operating and help patients improve them to reduce risks.
The Quick Take
- What they studied: Which health conditions and habits make it more likely that patients will have problems after skin surgery, and which ones can be changed to prevent complications.
- Who participated: Nearly 930,000 patients of all ages who had skin surgery (including procedures to remove moles, skin cancer, or other growths). The researchers used a large medical database to look at their health records and outcomes.
- Key finding: Five modifiable factors significantly increased complication risk: smoking (nicotine use), obesity, vitamin D deficiency, poorly controlled diabetes, and poorly controlled high blood pressure. Overall, only 1.7% of patients had complications, but those with these risk factors had higher rates.
- What it means for you: If you’re planning skin surgery, talk to your doctor about these five factors. If you smoke, are overweight, have low vitamin D, or have diabetes or high blood pressure that isn’t well-controlled, addressing these issues before surgery may reduce your risk of problems like infection or wound opening.
The Research Details
This was a retrospective cohort study, which means researchers looked back at medical records of patients who already had skin surgery and tracked what happened to them. They used a large database called TriNetX that contains health information from hundreds of thousands of patients across many hospitals and clinics. The researchers looked at three types of skin surgery: Mohs micrographic surgery (a special technique for skin cancer), removal of malignant (cancerous) growths, and removal of benign (non-cancerous) growths. To make fair comparisons, they used a statistical technique called propensity scoring to match patients with similar characteristics, so differences in outcomes would be due to the risk factors being studied rather than other differences between groups.
This approach is valuable because it looks at real-world outcomes from a huge number of patients rather than just a small group in a controlled setting. By studying nearly 930,000 patients, the researchers could identify patterns that might not show up in smaller studies. The use of propensity scoring helps ensure that when they find a risk factor matters, it’s actually the risk factor causing the problem and not some other difference between patients.
Strengths: Very large sample size gives reliable results, real-world data from actual patient outcomes, careful statistical methods to control for other factors. Limitations: Retrospective design means researchers couldn’t control all variables like they could in an experiment, some important information might be missing from medical records, and the study only looked at complications within 30 days of surgery.
What the Results Show
The overall rate of complications was quite low at 1.7%, which is reassuring. However, the study identified five modifiable factors that significantly increased this risk. Smoking (nicotine use) was one of the strongest predictors of complications. Being obese also raised the risk. Patients with vitamin D deficiency had higher rates of infection and wound dehiscence (where the surgical wound opens up). Diabetes and high blood pressure that were poorly controlled—meaning blood sugar and blood pressure weren’t at target levels—were associated with more complications compared to patients whose conditions were well-controlled. Interestingly, patients taking certain strong immune-suppressing medications (like methotrexate) did not show increased complication rates, suggesting these medications may not be as risky for this type of surgery as previously thought.
The study also found that certain blood-thinning medications (anticoagulants like warfarin and apixaban, and antiplatelets like aspirin) predicted complications, which makes sense because these medications can increase bleeding. Oral corticosteroids (steroid medications taken by mouth) were associated with infection and wound opening problems. These secondary findings help doctors understand the full picture of medication risks when planning surgery.
This research confirms what doctors have long suspected about smoking, obesity, and poorly controlled diabetes increasing surgical risks. The finding about vitamin D deficiency is particularly interesting because it highlights a specific nutritional factor that hasn’t always been emphasized in surgical planning. The finding that immune-suppressing medications didn’t increase risk contradicts some earlier concerns and may reassure patients who need these medications for other conditions.
The study only tracked complications for 30 days after surgery, so longer-term problems weren’t captured. Because it’s a retrospective study looking at past records, some important health information might be missing or incomplete. The database may not represent all populations equally, so results might not apply to everyone. The study couldn’t prove that these factors directly cause complications, only that they’re associated with higher risk. Additionally, the overall complication rate was low, so even though certain factors increased risk, the absolute risk remained small for most patients.
The Bottom Line
Before skin surgery, discuss these five factors with your doctor: (1) If you smoke, try to quit or reduce before surgery—this has strong evidence of reducing complications. (2) If you’re overweight, even modest weight loss may help. (3) Get your vitamin D level checked and supplement if low—moderate evidence supports this. (4) If you have diabetes, work with your doctor to get blood sugar well-controlled before surgery—strong evidence supports this. (5) If you have high blood pressure, ensure it’s well-controlled—strong evidence supports this. These changes may take weeks to months, so start early if you have planned surgery.
Anyone planning skin surgery should pay attention to these findings, especially if you have one or more of these risk factors. This is particularly important for people with diabetes or high blood pressure, smokers, and people who are overweight. If you’re taking blood-thinning medications, discuss with your doctor whether they should be adjusted before surgery. People with normal weight, good blood sugar control, normal blood pressure, and who don’t smoke have lower baseline risk and may not need to make changes.
Quitting smoking can improve wound healing within days to weeks. Getting vitamin D levels up typically takes 4-8 weeks with supplementation. Losing weight takes longer—aim for gradual loss over several months if possible. Getting diabetes and blood pressure under control may take 2-4 weeks with medication adjustments. Ideally, start addressing these factors 4-8 weeks before planned surgery.
Want to Apply This Research?
- Track daily nicotine use (cigarettes, vaping), weekly weight, and daily blood pressure and blood sugar readings if applicable. Set a goal to reduce nicotine use by 50% within 2 weeks and eliminate it 4 weeks before surgery.
- Use the app to set reminders for vitamin D supplementation (if deficient), daily blood pressure checks, and weekly weigh-ins. Create a pre-surgery countdown that shows progress on each of the five modifiable factors, with specific targets for each week leading up to surgery.
- For 8 weeks before surgery, track the five factors weekly: nicotine use (days without), weight trend, vitamin D supplementation compliance, blood sugar average (if diabetic), and blood pressure average (if hypertensive). After surgery, continue tracking for 30 days to monitor for any early signs of complications like increased redness, warmth, or wound opening.
This research provides general information about risk factors for skin surgery complications but should not replace personalized medical advice. If you’re planning skin surgery, discuss these findings with your dermatologist or surgeon, who can assess your individual risk factors and recommend specific steps to reduce your complication risk. This study looked at associations, not definitive cause-and-effect relationships. Always follow your doctor’s specific pre-surgery and post-surgery instructions, as they may differ from general recommendations based on your individual health situation.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.