title: Predictors of patient satisfaction with Mohs surgery: analysis of preoperative, intraoperative, and postoperative factors in a prospective cohort.
abstract: OBJECTIVE
  To identify preoperative, intraoperative, and postoperative variables that predict higher short- and long-term patient satisfaction with Mohs surgery.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A university-based dermatology practice and the affiliated Veterans Affairs medical center dermatology clinic.
  
  
  METHODS
  A total of 339 consecutive patients treated with Mohs surgery in 1999 and 2000.
  
  
  METHODS
  Short-term satisfaction at 1 week and long-term satisfaction at 1 year. We used directed acyclic graphs to determine appropriate confounding adjustment for preoperative, intraoperative, and postoperative variables that influence satisfaction with Mohs surgery in logistic regression models.
  
  
  RESULTS
  Better preoperative skin-related quality of life (measured using Skindex) and more intraoperative Mohs stages were the most salient predictors of higher short- and long-term satisfaction; these odds ratios (ORs) were 2.33 (95% CI, 1.01-5.35) and 5.19 (1.66-16.29), respectively, for preoperative skin-related quality of life and 7.06 (2.02-24.67) and 5.30 (1.24-22.64), respectively, for more intraoperative Mohs stages. Patients not bothered by postoperative bleeding were more likely to be satisfied short term (OR, 2.25; 95% CI, 1.25-4.05), as were those who considered themselves involved in decision making about their treatment (3.05; 1.52-6.10). Higher long-term satisfaction with Mohs surgery was observed among patients who were married (2.36; 1.10-5.09).
  
  
  CONCLUSIONS
  Higher short- and long-term satisfaction with Mohs surgery is predicted by better preoperative skin-related quality of life and by more intraoperative Mohs stages. The effect of postoperative variables wanes over time, suggesting that factors influencing satisfaction can vary depending on the time frame when satisfaction is measured. Our results may help clinicians identify patients who are at higher risk of dissatisfaction following Mohs surgery.
authors.affiliation: Division of Research, Kaiser Permanente Northern California, Oakland , California 94612, USA. maryam.m.asgari@kp.org
authors.forename: Maryam M
authors.initials: MM
authors.lastname: Asgari
authors.forename: E Margaret
authors.initials: EM
authors.lastname: Warton
authors.forename: Romain
authors.initials: R
authors.lastname: Neugebauer
authors.forename: Mary-Margaret
authors.initials: MM
authors.lastname: Chren
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D017533:Marital Status / Q000706:statistics & numerical data; D008875:Middle Aged; D015580:Mohs Surgery / Q000379:methods*; D010358:Patient Participation / Q000706:statistics & numerical data*; D017060:Patient Satisfaction; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D011788:Quality of Life; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome