JMIR Publications

ABSTRACT

Background:

Hidradenitis suppurativa (HS) is a painful inflammatory disorder that confers significant distress to patients, with surgery as an integral treatment modality.

Objective:

To inform improvements in care, patterns in HS surgery were assessed.

Methods:

A retrospective population-based analysis was performed on Ontario billing claims for HS surgery across 10 years. The top five billing specialties, including general and plastic surgery, were analyzed.

Results:

A total of 7,195 claims for the excision of inguinal, perineal or axillary skin and sweat glands for HS were submitted across the study period. Annual HS surgery claims showed an increasing trend across 10 years, ranging between 4.9-5.8 per 100,000 population. The number of providers steadily decreased, ranging between 1.7-1.9 per 100,000, with approximately twice as many general than plastic surgeons. The mean annual number of procedures per physician rose from 2.8 to 3.1. In rural areas, general surgeons performed the majority of surgeries (65.8%), while in urban areas surgeries were more equally performed by general (50.4%) and plastic (48.1%) surgeons. Of HS surgery claims, 25.7-35.9% were provided by a physician residing in a different area than the patient receiving care.

Conclusions:

No significant improvements in access to HS surgery were seen across the study period, with access potentially worsening. System barriers across the continuum of HS diagnosis and management must be evaluated to improve access to surgical care.