432 Perioperative Antithrombotic Agent Use in Cutaneous Surgery: A Complete Audit Cycle

Aim Management of antithrombotic therapy prior to cutaneous surgery is a contentious topic with mixed opinions. The primary of this audit was to analyse the incidence of post-operative bleeding following cutaneous surgery in our minor operations theatre over two audit cycles. Secondary aims included measuring the standards outlined by BSDS and BSH peri-operative antithrombotic guidelines and assessing bleeding by risk. Method A single centre retrospective review of all patients undergoing cutaneous surgery on established antithrombotic therapy between 8/9/22 - 31/10/22 (cycle 1) and 10/7/2023 to 15/09/2023 (cycle 2) was conducted. A poster 'cheat sheet' containing antithrombotic agent advice was displayed in the department, forming the intervention. Results A total of 165 patients underwent cutaneous surgery with continuation of their antithrombotic agent. A reduction in post-operative bleeding from 8.6% to 7.4% in the second cycle was observed. The most common agent associated with bleeding in both cohorts was a DOAC, 33.3% and 42.9%, respectively. Overall, high risk operations had a proportionally higher incidence of post-op bleed compared with lower risk; 26.7% versus 4.6%, respectively. We recommended aspirin monthotherapy was not ceased before surgery, this improved from 80% to 71.4%. Equally we saw an increase in pre-op INR from 75% to 100% for warfarin users. Conclusions Patient factors, indication for antithrombotic agent and risk of the procedure should be all considered when listing for surgery, to help determine how the antithrombotic agent should be managed. Postoperative bleeding increases the risk of delayed wound healing, graft/flap failure and wound infection, and therefore should be considered.