Introduction Acute perianal abscess is the seventh most common emergency general surgery condition (18,000 cases/year).1This study investigates the current management and health outcomes with the aim of demonstrating feasibility for a randomised controlled trial of packing versus no packing.
Method Demographic and operative data was collected for all patients. Patients were asked to complete pain score diaries and QoL assessments using VAS and EQL-5D respectively, in addition to 1, 2, 3, 4, 8 week and 6 month follow up. This interim analysis was undertaken 11 months from study inception.
Results 142 patients were recruited over 10 months at 15 centres. Mean age 39 years, 64% female.
At operation, 9% had a fistula identified (no fistulotomies) and 97% were packed. Average number of dressing changes in 21 days was 7.4.
Packing causes a double to three-fold increase in pain. Pain intensity halves after a week (Table 1).
At 4 weeks, 48% healed. 8 week fistula rate was 21% and recurrence rate 9% (n = 2) at 6 months. 26 patients withdrew consent or were lost to follow-up.
The estimated dressing and community nursing costs are £159.84 per patient, equating to £2,877,120 in England alone (18,000 patients per annum).
Conclusion Packing is painful. A trial of packing versus no packing, based on pain scores, is feasible. If no packing is shown to be beneficial in terms of reduced pain and safe (no increased fistula or abscess recurrence rates), there could be considerable cost savings to the NHS and to patients, including reduced absence from work.
Disclosure of interest None Declared.
Hospital Epsiode Statistics. www.hscic.gov.uk/hes
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