Retrospective cohort reports long-term outcomes after surgery for craniofacial hyperhidrosis

A 10-year retrospective cohort study of 127 patients found immediate relief of craniofacial sweating after bilateral R2 sympathetic surgery, but severe compensatory hyperhidrosis (CH) was reported in 70.1%. The internally validated prediction models identified factors associated with severe CH and postoperative satisfaction, but require external validation.

All 127 patients had immediate relief of craniofacial sweating.
Severe compensatory hyperhidrosis occurred in 70.1%.
Higher baseline heart rate and sympathetic clamping predicted severe CH.
Prediction models need external validation.

Researchers retrospectively analyzed records and telephone follow-up for 127 patients who underwent bilateral R2 sympathetic surgery for craniofacial hyperhidrosis between April 2013 and April 2023. They assessed long-term sweating outcomes and satisfaction, and developed internally validated models to predict severe compensatory hyperhidrosis (CH) and satisfaction.

All patients had immediate resolution of craniofacial sweating. Severe CH developed in 70.1%; the thoracoabdominal region was affected in 84.3% of these patients and the thighs in 54.3%. Preoperative heart rate above 79.5 beats per minute was associated with severe CH (hazard ratio 2.46, 95% CI 1.61–3.75), as was sympathetic clamping (HR 5.69, 95% CI 3.03–10.67). Lower baseline thoracoabdominal sweating was associated with higher postoperative satisfaction. The authors report that CH severity stabilized within the first postoperative year.

These findings may inform preoperative discussions about symptom relief and compensatory sweating. However, the study was retrospective, and the proposed prediction models were only internally validated; external validation is needed before routine use. The supplied report does not provide detailed follow-up completeness or absolute satisfaction rates.

In practice

For patients considering bilateral R2 sympathetic surgery for craniofacial hyperhidrosis, this cohort suggests immediate relief may be accompanied by a substantial risk of severe compensatory sweating: 70.1% of 127 patients developed severe CH. Preoperative heart rate above 79.5 bpm and sympathetic clamping were associated with greater risk, while lower baseline thoracoabdominal sweating was associated with higher satisfaction. These retrospective findings may support risk discussions, but the prediction models have only internal validation and should not be treated as established individual risk estimates.

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Source

Surgical Endoscopy: Bilateral R2 sympathetic surgery for craniofacial hyperhidrosis: a 10-year retrospective cohort study on long-term outcomes and development of a prognostic predictive model ↗

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