Electrosurgery and Implantable Electronic Devices: A Survey of Current Practices among Cutaneous Surgeons
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Keywords
Electrosurgery, Implantable Electronic Device, Pacemaker, Cardioverter-Defibrillator, Deep brain stimulator, Cochlear implant, Spinal cord stimulator, nerve stimulator, cutaneous surgery
Abstract
Background: The use of electrosurgery within dermatology is widespread and the number of patients with an implantable electronic device (IED) is ever-increasing. Adverse effects of performing electrosurgery on patients with IEDs could pose a significant patient safety risk. There is a paucity of literature existing detailing guidelines for cutaneous surgeons regarding electrosurgery in IED patients.
Objective: To assess current practices and complications of cutaneous surgeons performing electrosurgery in IED patients.
Methods: An electronic survey was distributed to members of the American College of Mohs Micrographic Surgery using REDCap. Data was collected between March 2019 and May 2019.
Results: The survey was sent to approximately 1700 ACMS members with 178 responses received. The most commonly reported routine precautions included utilization of only short bursts of current, avoidance of electrosurgery around the device, and use of minimal power/lowest effective settings. In total there were nine complications with an estimated 31 patients experiencing electromagnetic interference (EMI) out of over 250,000 procedures. Complications were more commonly seen in patients with a cardioverter-defibrillator than any other device (RR:4.74, CI:1.29-17.4). The use of true heat cautery and bipolar (two-tip electrode) were associated with the lowest rate of EMI. Whereas, electrocoagulation, electrosection, and monopolar (single-tip electrode) were more likely to cause EMI (RR:3.62, 95% CI:1.82-7.19).
Conclusions: Significant EMI to IEDs during routine cutaneous electrosurgery procedures is rare, however, there is a clear lack of recommendations. The use of bipolar forceps and electrocautery may be safer when electrosurgery is required. Further investigation is required to develop guidelines for electrosurgery in IED patients.
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Caroline Rose Morris, Department of Internal Medicine, Division of Dermatology, Washington University, St Louis, Missouri
Dermatology Resident PhysicianEva A Hurst, Department of Internal Medicine, Division of Dermatology, Washington University, St Louis, Missouri
Associate Professor of Dermatology
Director, Dermatologic Surgery