J. A. Sobrino1, J. A. Sujka1, L. A. Benedict1, J. D. Fraser1, T. B. Lautz2, T. A. Oyetunji1 1Children’s Mercy Hospital – University Of Missouri Kansas City,Department Of Surgery,Kansas City, MO, USA 2Ann & Robert H. Lurie Children’s Hospital of Chicago,Department Of Surgery,Chicago, IL, USA
Introduction:
Pediatric breast abscesses are rare. Data is lacking on their epidemiology and management. Adult literature has demonstrated that aspiration and antibiotics are a safe and effective first line treatment with incision and drainage (I&D) reserved for complicated collections or failure of aspiration. I&D is of particular concern in the pediatric population given the unique concern of injury to the pre-pubertal breast bud leading to a cosmetic defect. The purpose of our study was to evaluate the current national management of pediatric breast abscesses.
Methods:
A retrospective review was conducted utilizing the Pediatric Health Information System (PHIS) database including patients less than 18 years old with appropriate ICD 9 and 10 diagnostic codes for breast abscesses and corresponding procedure codes for I&D or aspiration. Patients with length of stay greater than 5 days were excluded. Details were collected on demographics, imaging, procedures, comorbidities, length of stay, and 30-day re-admissions. Medians are reported with interquartile ranges.
Results:
A total of 3,381 patients were included. Only female patients were analyzed, and this included 2,796 patients (83%). Median age at presentation was 13 years (7, 15). Seventeen percent (481) occurred in patients less than a year old. Toddler and early childhood ages accounted for 4% of patients each before increasing in middle childhood (9%) and early adolescence (60%). The racial composition was 46% white and 36% black.
Fifty-seven percent of patients had no imaging performed and 43% (1,199) underwent an ultrasound. Four hundred and eighty patients (17%) underwent I&D, 192 (7%) underwent aspiration, and 60 (2%) patients were treated with interventional radiology guided drainage. I&D rates varied from 16% to 28% by age group and 0 to 50% by hospital. There were no differences in rates of aspiration (p = 0.536) or I&D (p = 0.056) between age groups.
Mean length of stay was 1.3 days. Length of stay was longest in infants (1.8 days, p = < 0.005). The length of stay was shorter for I&D compared to aspiration (1.6 vs 1.9 days, p = 0.002). The overall 30 day readmission rate was 17% (482). There was no difference in readmission rate between those treated with I&D compared to aspiration (16% vs 14%, p = 0.64).
Conclusion:
Despite concerns for damage to a developing breast bud, rates of I&D are high throughout the nation. Overall the management of pediatric breast abscesses is variable and needs standardization with long term follow up of the two most common methods of drainage. Further study is needed.
