Treatment options for patients with pilonidal sinus disease: PITSTOP, a mixed-methods evaluation.
Steven Brown1, Daniel Hind2, Emily Strong2
1Department of General Surgery, Northern General Hospital, Sheffield, UK.
Health Technology Assessment (Winchester, England)
|July 24, 2024
Summary
Pilonidal disease surgery often has a greater burden than expected, with major procedures causing more pain and complications. Patient preferences for treatment balance recovery time against risks, guiding future research and practice for less disruptive interventions.
Area of Science:
- Surgical Management
- Pilonidal Disease
- Patient-Reported Outcomes
Background:
- Optimal management for pilonidal disease lacks consensus, with varied surgical practices and limited high-quality evidence.
- Existing literature often comprises single-center studies with diverse patient populations, interventions, and outcome assessments.
Purpose of the Study:
- To investigate the relationship between disease severity and surgical intervention outcomes in pilonidal disease.
- To identify patient-valued outcomes and treatment preferences.
- To provide recommendations for policy and future research in pilonidal disease management.
Main Methods:
- Prospective observational cohort study incorporating a nested mixed-methods case study.
- Utilized a discrete choice experiment, clinician survey, and a three-stage Delphi survey for patients and clinicians.
- Employed regression modeling, propensity score-based approaches, and augmented inverse probability weighting for outcome comparison.
Main Results:
- Major surgical procedures (60% of cases) were associated with increased postoperative pain, higher complication rates, and longer recovery times compared to minor procedures.
- Patient treatment choices were significantly influenced by the risk of disease persistence (70% importance) and shorter recovery time (30% importance).
- Patient decision-making was affected by prior disease experience and anticipated recovery, with a notable rejection of 'excision-and-leave-open' due to extensive nursing care.
Conclusions:
- The burden of pilonidal surgery is substantial and can be mitigated by aligning interventions with disease type and patient goals.
- Future high-quality trials should stratify disease severity, group common interventions, and develop patient-centered core outcome sets.
- Priorities include comparative trials of broadly grouped interventions and surgical approaches less disruptive than the disease itself.
