Background: Current guidelines for management of anorectal abscesses make no recommendations for operative vs bedside incision and drainage (I&D). The purpose of this study was to determine if management in the operating room is necessary to adequately drain anorectal abscesses and prevent short-term complications for patients presenting to the emergency department (ED).
Methods: Patients with perirectal abscesses were identified and divided into two groups based on intervention type: "bedside" or "operative." Demographic, laboratory, and encounter data were obtained from the medical record. Study outcomes included 30-day complications (return to the ED, reintervention, and readmission). Data were analyzed with univariate and multivariate analyses using SPSS (version 28).
Results: A total of 113 patients with anorectal abscesses were identified. Sixty-six (58%) underwent bedside I&D and 47 (42%) operative I&D. The overall complication rate was 10%. A total of 9 patients (6 bedside and 3 operative) returned to the ED. Six of these patients required reintervention (5 bedside and 1 operative), and 1 was readmitted. Two patients from the bedside group required a second I&D during their index admission. Pre-procedure SIRS (P = .02) was found to be associated with 30-day complications. Provider specialty and training level were not associated with 30-day complications.
Discussion: In this study, for patients presenting to the ED, bedside drainage was found to be an adequate management strategy to achieve complete drainage without a significant increase in the rate of complications when compared to operative drainage.
Keywords: anorectal abscess; bedside incision and drainage; emergency room.