Laser Epilation for Pilonidal Disease May Be Safely Provided by Nonphysicians
Owen Henry, BS, Katherine Fry, BS, Hajar Delshad, MS, PA-C, Susan Zotto, BSN, RN, CPN, David P. Mooney, MD, MPH Department of Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA.
Background:
Laser epilation (LE) is a valuable component of the care of adolescents with pilonidal disease, but the staffing necessary to provide this service remains unclear given studies reporting increased complications when LE is provided by nonphysician operators. We compared the complication rate of LE provided by a physician, physician assistant (PA) and registered nurse (RN) in a dedicated Pilonidal Care Clinic.
Methods:
We reviewed data from patients who underwent LE from February, 2015 to January, 2019 in our Pilonidal Care Clinic. Demographics, disease severity, number of LE’s, LE provider, and complications by LE provider were analyzed. Alexandrite or Nd:Yag laser wavelengths were used, based upon patients’ Fitzpatrick skin type. All providers completed training mandated by the laser manufacturer and hospital.
Results:
190 patients underwent 657 LE’s, a median of 3 per patient. 81% were male with average age 17.4 years, average BMI 27.5, and average follow-up 11.7 months. Presenting disease severity was mild (35, 18.4%), moderate (106, 55.8%), severe (42, 22.1%), or dehisced (3, 1.6%). Most patients (120, 63%) underwent sinusectomy during their laser course. Of 657 LE’s, 204 (31%) were MD provided, 343 (52%) PA, and 96 (15%) RN. Two patients (0.3%) had minor skin complications after LE, both MD provided using appropriate Nd:Yag settings. No complications resulted from PA or RN provided LE.
Conclusion:
Laser epilation for pilonidal disease has a very low complication rate and may be safely provided by nonphysicians, allowing efficient staffing in a pilonidal clinic.
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