The surgical management of cutaneous abscesses: A UK cross-sectional survey

Thomas, Owen; Ramsay, Alistair; Yiasemidou, Marina; Hardie, Claire; Ashmore, Daniel; Macklin, Christopher; Bandyopadhyay, Dibyendu; Patel, Bijendra; Burke, Joshua R.; Jayne, David

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.

Citation

Thomas, O., Ramsay, A., Yiasemidou, M., Hardie, C., Ashmore, D., Macklin, C., Bandyopadhyay, D., Patel, B., Burke, J. R., & Jayne, D. (2020). The surgical management of cutaneous abscesses: A UK cross-sectional survey. Annals of Medicine and Surgery, 60, 654-659. https://doi.org/10.1016/j.amsu.2020.11.068

• Journal Article Type: Article
• Acceptance Date: Nov 24, 2020
• Online Publication Date: Nov 27, 2020
• Publication Date: 2020-12
• Deposit Date: Jan 27, 2021
• Publicly Available Date: Feb 1, 2021
• Journal: Annals of Medicine and Surgery
• Print ISSN: 2049-0801
• Electronic ISSN: 2049-0801
• Publisher: Elsevier
• Peer Reviewed: Peer Reviewed
• Volume: 60
• Pages: 654-659
• DOI: https://doi.org/10.1016/j.amsu.2020.11.068
• Keywords: Cutaneous abscess; Antibiotics; Packing; ‘Incision and drainage’; Local anaesthetic
• Public URL: https://hull-repository.worktribe.com/output/3700425
• Publisher URL: https://www.sciencedirect.com/science/article/pii/S2049080120304957?via%3Dihub