# Shared decision making for perioperative antibiotic use during Mohs micrographic surgery on the lower extremities

## TL;DR

This study shows that shared decision making reduces antibiotic use without increasing infection risk after a specific skin surgery on the lower extremities.

## Contribution

This is the first study to apply shared decision making in dermatologic surgery for antibiotic use.

## Key findings

- Patients in the shared decision making group had lower antibiotic prescription rates (20% vs. 50%).
- Shared decision making did not increase surgical site infection rates (8% vs. 7.7%).
- Patient satisfaction was significantly higher in the shared decision making group.

## Abstract

While there is a higher risk of surgical site infection (SSI) on the lower extremities following Mohs micrographic surgery (MMS), antibiotic prophylaxis (AP) is debated.

To determine the role of shared decision making (SDM) in guiding AP usage during MMS on the lower extremities.

A prospective observational study was conducted whereby patients received a standardized SDM discussion or routine counseling. Patient satisfaction quantified by the shared decision-making questionnaire (SDMQ9) survey, rate of SSI, and rate of AP prescription were recorded.

In total, 51 patients were included. While there were less antibiotics prescribed in the treatment group (20% versus 50%, P = .025), this did not affect incidence of SSI (8% in treatment group versus 7.7% in control group, P = .668). Patient satisfaction was statistically greater in SDM group (4.73 versus 2.18 in control (P < .001).

Patient satisfaction scores were higher among the patients who received SDM. While the usage of AP was lower in the SDM group, this did not affect incidence of SSI. This study allows the opportunity to apply SDM in the setting of MMS, which to our knowledge has not yet been attempted in the field of dermatologic surgery.