Operative Incision and Drainage for Perirectal Abscesses: What are Risk Factors for Prolonged Length of Stay, Reoperation, and Readmission?

Perirectal abscess is a common problem. Despite a seemingly simple disease to manage, clinical outcomes of perirectal abscesses can vary significantly given the wide array of patients that are susceptible to this disease.Our aims were to evaluate the outcomes following operative incision and drainage for perirectal abscess and to examine factors associated with length of stay, reoperations and readmissions.Retrospective analysis of the National Surgical Quality Improvement Program database.Hospitals participating in the surgical database.Adult patients undergoing outpatient perirectal abscess procedures from 2011 through 2016.Study outcomes were length of stay, reoperation and readmission.We identified 2,358 patients undergoing incision and drainage for perirectal abscesses. Approximately 35% of patients required hospital stay. Reoperations occurred in 3.4% with median time to reoperation of 15.5 days. The majority of reoperations (79.7%) were performed for additional incision and drainage. Readmissions rate was 3.0% with median time to readmission of 10.5 days. Common indications for readmissions included recurrent/persistent abscess (41.4%) and fever/sepsis (8.6%). Risk factors for hospitalization in multivariable analysis were preoperative sepsis, bleeding disorder, non-Hispanic Black and Hispanic races. For reoperations, risk factors included morbid obesity, preoperative sepsis and dependent functional status. Lastly for readmissions, female sex, steroid/immunosuppression and dependent functional status were significant risk factors.Retrospective analysis and potential selection bias in decisions on hospital stay, reoperation, and readmission.Suboptimal outcomes following outpatient operative incision and drainage for perirectal abscesses is not uncommon in the United States. In the era of value-based care, further work is needed to optimize utilization outcomes for high-risk patients undergoing perirectal incision and drainage. Strategies to prevent inadequate drainage at the time of the initial operative incision and drainage (i.e., use of imaging modalities, thorough exam under anesthesia) are warranted to improve patient outcomes. See Video Abstract at http://links.lww.com/DCR/B229.