S. Shraga1, O. Zayko1,2, B. Silverstein1, A. Gruessner1, T. Schwartz1 1Kings County Hospital Center, Brooklyn, NY, USA 2SUNY Downstate, General Surgery, Brooklyn, NY, USA
Introduction:
Perianal abscess is a common presenting complaint in the Emergency Department. Incision and drainage(I&D) is the standard of care for this disease. Despite adequate drainage there is a high recurrence and complication rate. In our busy inner city hospital, emergency physicians(ED) as well as general surgeons(GS) perform bedside I&D of perianal abscesses. Our aim is to analyze differences in patient demographics, management and outcomes based on type of provider performing I&D.
Methods:
A retrospective review of electronic medical records(EMR) of patients with bedside drainage of perianal abscess over a five year period(2010-2016). EMR’s were reviewed to evaluate differences in patient demographics and outcomes for those with drainage done by ED versus GS. Statistical analysis was done using chi-square and Fisher’s exact tests. Multivariate analysis was used to build predictive models.
Results:
Of 220 patients with perianal abscess 120 were drained at bedside; 97 were drained by GS and 23 drained by ED. Patients drained by ED were younger(p=0.02) and with less systemic signs of infection such as fever(p=0.01). The ED were more likely to use packing(p=0.01) and intravenous antibiotics(p=0.09). ED drainage had increased risk for thirty day complication(OR=10.1) and thirty day readmission(OR=5.1) using a model that adjusts for patient factors.
Conclusion:
While patients with perianal abscess treated by surgery tend to be sicker; they are less likely to have post procedure complications and readmission.