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. 2023 Feb;225(2):347-351.
doi: 10.1016/j.amjsurg.2022.09.005. Epub 2022 Sep 8.

Drainage of anorectal abscesses in the operating room is associated with a decreased risk of abscess recurrence and fistula formation

Sowmya Narayanan  1 , Alison R Althans  1 , Katherine M Reitz  1 , Laura H Allen  1 , Chareeni Kurukulasuriya  2 , Timothy M Larkin  3 , Nathan J Reinert  4 , Kellie E Cunningham  5 , Andrew R Watson  5 , James P Celebrezze  5 , David S Medich  5 , Jennifer Holder-Murray  6
Affiliations

Drainage of anorectal abscesses in the operating room is associated with a decreased risk of abscess recurrence and fistula formation

Sowmya Narayanan et al. Am J Surg. 2023 Feb.

Abstract

Background: Timely incision and drainage (I&D) is first line management for anorectal abscesses. We aimed to define current practices in anorectal abscess management and identify factors associated with abscess recurrence and fistula formation.

Methods: Index episodes of anorectal abscesses treated with I&D in 2014-2018 at a multi-hospital healthcare system were included. Association with one-year abscess recurrence or fistula formation was evaluated using Cox proportional hazard regression. Fistulae were captured only among patients without fistulae at the index operation.

Results: A total of 458 patients met study criteria. One-year rate of abscess recurrence or fistula formation was 20.3%. When compared to bedside procedures, drainage in the operating room was associated with a reduced risk of either recurrence or fistula formation (aHR 0.20 [95%CI 0.114-0.367]).

Conclusions: Improved exposure and patient comfort in the operating room may allow more complete drainage contributing to decreased rates of abscess recurrence or fistula formation.

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Conflict of interest statement

Declaration of competing interest The authors do not have any conflicts of interest related to this publication. This work was supported by the National Institutes of Health grants 5T32CA113263 (S.N.), 5T32HL098036 (L.H.A.), 5T32HL0098036 (K.M.R.), and L30AG064730 (K.M.R.).

Figures

Fig. 1.
Fig. 1.
Generation of study cohort and distribution of post-drainage adverse outcomes of abscess recurrence and/or fistula formation.
Fig. 2.
Fig. 2.. Frequency of abscess recurrence or fistula formation within one year of I&D of anorectal abscess.
Histogram demonstrating days to development of (A) abscess recurrence (whole cohort) or (B) fistula among patients who did not have a fistula at the index operation. The overlying curves represent univariate kernel density estimation.
Fig. 3.
Fig. 3.. One-year composite risk of abscess recurrence or fistula formation in patients drained in the operating room versus at the bedside.
OR, operating room.
See this image and copyright information in PMC

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