title: Factors associated with biopsy site identification, postponement of surgery, and patient confidence in a dermatologic surgery practice.
abstract: BACKGROUND
  Biopsy site identification is critical to avoid wrong-site surgery and may impact patient-centered outcomes.
  
  
  OBJECTIVE
  We sought to evaluate risk factors for biopsy site misidentification, postponement of surgery, and patient confidence in surgical site selection and to assess the near-miss rate for wrong-site surgeries.
  
  
  METHODS
  This was a prospective observational cohort study.
  
  
  RESULTS
  Near-miss wrong-site surgeries were detected and averted in 1.3% (3 of 239) of patients with biopsy site photographs. Risk factors for biopsy site misidentification by patients were 6 weeks or longer between biopsy and surgery (odds ratio [OR] 2.19, 95% confidence interval [CI] 1.12-4.27; P = .028) and patient inability to see biopsy site (OR 3.95, 95% CI 1.50-10.37; P = .002). Risk factors for physician misidentification were 6 or more weeks between biopsy and surgery (OR 3.68, 95% CI 1.40-9.66; P = .007) and biopsy specimens from multiple sites (OR 4.39, 95% CI 1.67-11.54; P = .003). Postponement of surgery was associated with absence of a biopsy site photograph (OR 12.5, 95% CI 2.79-62.21; P < .001). Patient confidence in surgical site identification was associated with the presence of a biopsy site photograph (OR 5.48, 95% CI 1.96-15.30; P = .001).
  
  
  CONCLUSIONS
  This was a single-site observational study.
  
  
  CONCLUSIONS
  Biopsy site photography is associated with reduced rates of postponed surgeries and improved rates of patient confidence in surgical site selection. Risk factors for biopsy site misidentification should be considered before definitive treatment.
authors: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Junqian
authors: J
authors: Zhang
authors: Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Alex
authors: A
authors: Rosen
authors: Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors: Lauren
authors: L
authors: Orenstein
authors: Department of Dermatology, Eastern Virginia Medical School, Norfolk, Virginia.
authors: Abby
authors: A
authors: Van Voorhees
authors: Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors: Christopher J
authors: CJ
authors: Miller
authors: Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors: Joseph F
authors: JF
authors: Sobanko
authors: Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania.
authors: Thuzar M
authors: TM
authors: Shin
authors: Department of Dermatology, University of Pennsylvania Health System, Philadelphia, Pennsylvania. Electronic address: jeremy.etzkorn@uphs.upenn.edu.
authors: Jeremy R
authors: JR
authors: Etzkorn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000067491:Near Miss, Healthcare; D017060:Patient Satisfaction; D010781:Photography; D011446:Prospective Studies; D012307:Risk Factors; D012867:Skin / Q000473:pathology*; D012871:Skin Diseases / Q000473:pathology* / Q000601:surgery*; D013997:Time Factors; D055815:Young Adult
keywords: Mohs; biopsy; excision; identification; photograph; skin cancer; wrong-site surgery