Outcomes of Crohn's disease presenting with abdominopelvic abscess.
OBJECTIVE
The aim of this study was to evaluate clinical outcomes, quality-adjusted life-years, and the cost-effectiveness gained from percutaneous drainage followed by elective surgery vs. initial surgery for abdominopelvic abscesses related to Crohn's disease.


METHODS
All consecutive patients with spontaneous Crohn's disease-related abdominopelvic abscess from 1997 to 2007 were reviewed. The authors excluded postoperative and perirectal abscesses. Decision analysis during one year of patient life was used to calculate quality-adjusted life-years and the cost-effectiveness of each strategy.


RESULTS
Of 94 patients, 48 (51 percent) were initially approached with percutaneous drainage. Thirty-one (65 percent) had successful percutaneous drainage and delayed elective surgery. The factors significantly associated with percutaneous drainage failure were steroid use, colonic phenotype, and multiple or multilocular abscesses. The initial treatment was surgery in the remaining 46 (49 percent) patients. The initial approach with percutaneous drainage gave higher quality-adjusted life-years and was more cost-effective than initial surgery. Percutaneous drainage was the optimal strategy in spite of the risk of failure and septic complications within the plausible range.


CONCLUSIONS
Percutaneous drainage failure is associated with steroid use, colonic phenotype, and multiple or multilocular abscesses. When feasible, percutaneous drainage is the most effective strategy from the perspective of patients and third-party payers.
da Luz Moreira
Andre
A
Department of Colorectal Surgery, Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, USA.
Stocchi
Luca
L
Tan
Emile
E
Tekkis
Paris P
PP
Fazio
Victor W
VW
D018784:Abdominal Abscess / Q000191:economics* / Q000209:etiology / Q000628:therapy*; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000009:adverse effects; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D003424:Crohn Disease / Q000150:complications*; D003661:Decision Support Techniques; D004322:Drainage / Q000191:economics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010641:Phenotype; D019057:Quality-Adjusted Life Years
D000305:Adrenal Cortex Hormones