Treatment method selection for perianal abscesses: bedside or operating room? a single center, retrospective study

This study aims to evaluate the effect of the type of intervention (bedside vs. operating room incision and drainage) on clinical outcomes in the treatment of perianal abscess and to identify predictive factors that may be effective in determining the type of intervention.

A retrospective study was conducted on 213 patients who underwent incision and drainage (I&D) for cryptoglandular perianal abscess. Patients were divided into 'bedside I&D' and 'operating room I&D' groups according to the type of intervention. Demographic characteristics, laboratory values, abscess size, early complications, and long-term fistula development were compared. Receiver operating characteristic (ROC) analysis was performed to determine cut-off values for white blood cell count (WBC), C-reactive protein (CRP), and abscess size; subsequently, logistic regression analyses were performed using these parameters.

WBC count, CRP levels, and abscess size were statistically significantly higher in the operating room group (p<0.001). According to ROC analysis, cut-off values were determined as 14.68×10⁹/L for WBC, 55.7 mg/L for CRP, and 29.5 mm for abscess size. While CRP lost statistical significance in univariate regression analysis, WBC and abscess size were identified as independent predictive factors for determining the intervention site in multivariate analysis. During long-term follow-up, fistula development was observed significantly more frequently in the operating room group (p=0.002).

WBC level and abscess size may be valuable predictors in deciding the type of intervention for perianal abscess treatment. Bedside I&D can be safely performed in low-risk cases, whereas operating room intervention should be preferred in patients with high inflammatory markers and larger abscesses.