Monitoring vital signs during outpatient Mohs and Post-Mohs reconstructive surgery performed under local anesthesia

BACKGROUND. Although dermatologic surgery carries a low risk of serious adverse events, concern over the safety of outpatient surgical procedures in general has led some to question whether intraoperative patient monitoring should be performed during all procedures performed in the clinic setting. OBJECTIVE. To characterize the intraoperative monitoring practices of Mohs surgeons and examine the relationship between changes in vital signs during skin surgery and the incidence of serious adverse events. METHODS. We surveyed a group of Mohs surgeons and prospectively measured blood pressure, pulse, and pulse oximetry of 100 patients undergoing repair of Mohs surgery defects under local anesthesia in the outpatient clinic setting. RESULTS. The majority of survey respondents utilize no intraoperative monitoring, and serious adverse events are rare (0.2 per 1000 procedures performed). Moderate fluctuations in our patients' vital signs occurred (< 10% deviation from baseline); however, all measured variables returned to near baseline by procedure end and were not associated with any serious adverse events. CONCLUSIONS. Surgical repair of Mohs defects performed under local anesthesia in the outpatient clinic setting continues to be very safe. Intraoperative vital sign measurements did not appear to be useful in detecting or avoiding potential adverse events in our patient population.