Pilonidal Disease: A Recent Decade of the Disease among Active Duty United States Military Service Members

Sacrococcygeal pilonidal disease (PD) is a common surgical problem in the U.S. Military. Despite recent advancements, treatment strategies remain heterogenous and incompletely described, particularly among the active duty component in the Military Health System (MHS). This study's objectives were to identify the burden of PD and describe current healthcare utilization and treatment patterns in the MHS during a recent 10-year study period.

The study population included all active duty U.S. service members with at least one PD diagnosis in the MHS Data Repository between January 1, 2013, and December 31, 2022. For each patient, the first PD diagnosis during the study period was the incident case, and a subsequent case was defined as a second PD diagnosis >30 days after the first and categorized as recurrent (procedure performed at incident encounter) or persistent (no procedure performed at incident encounter). Procedures were identified by Current Procedural Terminology codes.

During the study period, 25,039 active duty service members were diagnosed with an incident case of PD. The study population was mostly male, less than 30 years old, enlisted, and in the Army or Navy. The overall incidence rate was 1.7 per 1,000 person-years. Prevalence of recurrence was 44.6% (2,494 of 5,598) and persistence was 50.1% (9,731 of 19,441). Overall, there were 115,387 medical encounters with a PD diagnosis during the study period, and service members in the top 25% for healthcare utilization had ≥11 encounters with a PD diagnosis.

Pilonidal disease imposes a significant burden on the MHS and is a threat to overall force medical readiness. Treatment strategies remain heterogeneous, and prospective studies are needed to refine clinical guidelines.