1
|
Elkadi HH, Dodd E, Poulton T, Bolton W, Burke JR, Tiernan J, Jayne D. The effect of anaesthetic use on healing in sub cutaneous abscess management: a retrospective before and after cohort study. Ann R Coll Surg Engl 2023; 105:241-246. [PMID: 35616446 PMCID: PMC9974350 DOI: 10.1308/rcsann.2021.0362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION There is wide variation in the management of simple subcutaneous abscesses in the UK and no national guidelines describing best practice. During the SARS-CoV-2 pandemic, regional or local anaesthesia (LA) use was recommended instead of general anaesthesia. This study aimed to assess the effect of anaesthetic use on outcomes following incision and drainage (I&D) of simple subcutaneous abscesses. METHODS Two cohorts of patients undergoing abscess incision and drainage at St. James' University Hospital in Leeds were identified retrospectively over a 14-week period before (P1) and after (P2) the introduction of the COVID-19 anaesthetic guidelines. The number of follow-up appointments for repacking and representation to healthcare services 30 days after I&D were used as surrogate endpoints for wound healing. RESULTS A total of 133 patients were included (n=70, P1 and n=63, P2). Significantly more procedures were performed under LA after the intervention (84.1% vs 5.7%; p<0.0001) with a significant reduction in wound packing (68.3% vs 87.1%; p=0.00473). Follow-up analysis found no significant difference in the median number of follow-up appointments (7.46 vs 5.11; p=0.0731) and the number of patients who required ongoing treatment after 30 days (n=14, P1 vs n=14, P2; p=0.921). CONCLUSIONS Drainage of simple subcutaneous abscess under 5cm in diameter is safe under LA, with no significant difference in surrogate endpoints of wound healing observed in this patient cohort. Recurrent packing may not be required. Future work should explore patient-reported outcomes, including pain management, cosmesis and the cost and sustainability implications of a change in this common procedure.
Collapse
Affiliation(s)
- HH Elkadi
- St. James’s University Hospital, Leeds Teaching Hospital Trust, UK
| | - E Dodd
- St. James’s University Hospital, Leeds Teaching Hospital Trust, UK
| | | | - W Bolton
- St James’s University Hospital, Leeds, UK
| | | | | | | |
Collapse
|
2
|
Di Pietro S, Caracciolo E, Barcella B, Perlini S. Superficial cervical plexus block in Emergency Departments: rationale for its use in incision and drainage of neck skin abscesses. Intern Emerg Med 2022; 17:1533-1536. [PMID: 35670893 DOI: 10.1007/s11739-022-02992-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 04/12/2022] [Indexed: 11/05/2022]
Affiliation(s)
- Santi Di Pietro
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, P.le Golgi, 19 27100, Pavia, Italy
| | - Emilio Caracciolo
- Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, 19 27100, P.le GolgiPavia, Italy
| | - Bruno Barcella
- Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, 19 27100, P.le GolgiPavia, Italy.
| | - Stefano Perlini
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, P.le Golgi, 19 27100, Pavia, Italy
| |
Collapse
|
3
|
Thomas O, Ramsay A, Yiasemidou M, Hardie C, Ashmore D, Macklin C, Bandyopadhyay D, Bijendra Patel, Burke JR, Jayne D. The surgical management of cutaneous abscesses: A UK cross-sectional survey. Ann Med Surg (Lond) 2020; 60:654-659. [PMID: 33304582 PMCID: PMC7718210 DOI: 10.1016/j.amsu.2020.11.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 11/24/2020] [Indexed: 12/20/2022] Open
Abstract
Aim Cutaneous abscesses are one of the most common acute general surgery presentations. This study aimed to understand the current practice in the management of cutaneous abscesses in the United Kingdom (UK), once the decision has been made that acute surgical incision and drainage (I&D) is required. Method General surgeons from across the UK were surveyed on their opinions on the optimum management of cutaneous abscesses. Outcomes measured included anaesthesia, incision technique, antibiotic administration, departmental abscess pathways, and post-drainage management. A combination of Likert scales, multiple-choice questions, and short answer questions were used. Comparisons were made of Likert scales between regions using a two-sample independent t-test. The survey was peer reviewed and distributed through the Association of Coloproctology of Great Britain and Ireland (ACPGBI) network between April and June 2018. Results Sixty-one responses were collected from surgeons throughout the UK. Of these respondents, 69% indicated that cutaneous abscesses would always or usually require a General Anaesthetic (GA) for treatment, and 82% indicated that abscesses were at least sometimes not treated until the next day due to a lack of resources. While 79% of surgeons stated that pus swabs are always or are usually taken, 44% of respondents never or rarely chased the results. The main indications for giving antibiotics were sepsis/systemically unwell patients, and cellulitis. 31% of responding centres had an abscess management protocol, and 82% of respondents confirmed that they would always pack the abscess wound post-operatively. Conclusion ‘Incision and drainage’ is currently the most widely used technique for the surgical management of cutaneous abscess. However, this study demonstrates the significant variability in the use of anaesthesia, antibiotics, packing and the use of protocols to guide and streamline patient management. There are no current NICE guidelines specifically covering cutaneous abscess management. There is significant practice variation in the management of cutaneous abscesses across the UK. Wound packing is still commonplace, despite guidelines recommending that there is evidence that it should be avoided. New recommendations on the use of antibiotics whilst treating cutaneous abscesses are yet to be taken up by most surgeons. Surgically managed cutaneous abscesses in the UK are preferably managed under a general anaesthetic.
Collapse
Affiliation(s)
- Owen Thomas
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Alistair Ramsay
- The John Golligher Colorectal Surgery Unit, St. James's University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - Marina Yiasemidou
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Claire Hardie
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James's University Hospital, Leeds, LS9 7TF, UK
| | - Daniel Ashmore
- Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James's University Hospital, Leeds, LS9 7TF, UK
| | | | | | - Bijendra Patel
- Barts Health NHS Trust, Whitechapel Rd, London, E1 1FR, UK
| | - Joshua R Burke
- The John Golligher Colorectal Surgery Unit, St. James's University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, LS9 7TF, UK.,Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James's University Hospital, Leeds, LS9 7TF, UK
| | - David Jayne
- The John Golligher Colorectal Surgery Unit, St. James's University Hospital, Leeds Teaching Hospital Trust, Beckett Street, Leeds, LS9 7TF, UK.,Leeds Institute of Biomedical & Clinical Sciences, Clinical Sciences Building, St James's University Hospital, Leeds, LS9 7TF, UK
| |
Collapse
|