Management of Acute Abscesses by Day-Case Surgery: A Retrospective Analysis and Feasibility Study

The management of acute abscesses is a common problem that is faced by surgical departments around the world. Once the decision is made to proceed to surgical drainage, allocating patients to an operative list can lead to delays and unnecessary admission to hospital overnight. The British Association of Day Surgery recognises acute abscess as a condition that can be managed in Day Surgery Centres. We retrospectively reviewed 100 abscess incision and drainages in our University Teaching Hospitals' Acute General Surgery department to see what parameters would make a patient suitable to undergo this procedure as a day-case surgery. This analysis was performed in the hope of implementing a new pathway for their care to streamline the emergency operating list. A total of 83 patients were suitable to be included in the analysis. Of these 83 cases, 71 patients were discharged on the day of surgery, giving us an 85.5% day-case rate. We found that pilonidal and trunk abscesses had a 100% (23 out of 23 cases) day-case rate while patients who also suffered from diabetes had only a 71.4% day-case rate (10 out of 14 cases). The rate of overnight admission increased as American Society of Anesthesiologists (ASA) score increased and perianal abscesses while being the most frequently operated upon, had only a 76.9% day of surgery discharge rate (20 out of 26 cases). We felt reassured by the research that with proper patient selection a large percentage of our abscesses could be managed in a Day Surgery Unit and we have begun implementation of this pathway. We hope it can reduce unnecessary hospital admissions, reduce pressures on emergency theatres and prevent patients from waiting prolonged periods of time for an urgent operation.