O. Renteria1, H. Cunningham1, V. Jain1, M. S. Sultany1, M. Ruiz1, S. Huerta1,2, S. Huerta1,2 1University Of Texas Southwestern Medical Center,Surgery,Dallas, TX, USA 2VA North Texas Health Care System,Surgery,Dallas, TX, USA
Introduction: Pilonidal Disease (PD) affects primarily young, adult men with highest prevalence in the second decade of life. The Veteran Administration (VA) patient population is composed primarily of older men. The aim of this study was to investigate the incidence and outcomes of veteran patients that underwent surgical treatment of PD.
Methods: A retrospective review of all patients treated for pilonidal Disease at the VA North Texas Health Care System over the past 12 years (2005-2017) was performed. Univariate and multivariate analysis was undertaken to analyze outcomes.
Results: 122 patients were identified with mean age 41.4 ± 17.6 years-old; male = 95.0%; White = 73.8%; BMI = 33.1 ± 7.5 kg/m2; ASA III-IV = 30.3%. Recurrence and complication rates were 10.7% and 22.1%, respectively. Most patients (65.6%) underwent excision with primary closure. The most common complications were wound dehiscence and infection. No comorbid condition was identified as an independent predictor of complications or recurrence. Longer operative times (OR 1.037, 95% CI: 1.001– 1.075) and older age (OR 1.037, 95% CI: 1.000 – 1.076) emerged as the only independent predictors for complications. No significant difference in complications and recurrence was determined between primary closure and secondary intention healing. There was no difference in the complication rate between colorectal surgeons and general surgeons performing the surgery (p = 0.13), but recurrence was higher for colorectal surgeons (28.0%) compared to general surgeons (6.2%; p = 0.005).
Conclusion: The incidence of PD in Veteran patients is low, but it is associated with substantial morbidity and recurrence. In this small cohort, no comorbid factor revealed to be a predictor for complications or recurrence, but longer operative time and age are predictors of complications. Surgical outcomes were similar to previous studies, however, no surgical method was identified as an optimal standard and management of Veteran patients presenting with PD should be individualized.