title: Minimally invasive drainage of subcutaneous abscesses reduces hospital cost and length of stay.
abstract: OBJECTIVE
  We compared outcomes among pediatric patients managed with minimally invasive (MI) packing techniques with those managed with traditional packing techniques for drainage of subcutaneous abscesses.
  
  
  METHODS
  After institutional review board approval, medical records of children requiring drainage of subcutaneous abscesses between January 2010 and June 2011 were reviewed. Data were collected on patient demographics, abscess location, surgical procedure, microbiology cultures, and hospital length of stay (LOS). The hospital accounting system was queried for direct and indirect costs. We compared LOS and cost data among groups managed with MI versus traditional packing techniques.
  
  
  RESULTS
  Incision and drainage was performed on 329 children (57.8% girls, 72% white, mean age of 43 months [range <1 to 218]). Of the total abscesses 198 (60.2%) were located in the groin/buttocks/perineum. Methicillin-resistant Staphylococcus aureus was identified in 74% of culture specimens. A total of 202 patients (61.4%) underwent packing and 127 (38.6%) underwent MI drainage. MI drainage ranged from 0% (0/110) in January to June 2010 to 34.6% (44/127) in the July to December 2010 transition period and reached 90.2% (83/92) in 2011 (P < 0.001). Median LOS decreased from 2 days (interquartile range 1-2) in the packing-only period to 1 day (interquartile range 1-2) in the predominantly MI period (P < 0.001). Hospital costs decreased with the transition to the MI technique (P < 0.001). MI drainage was associated with a $520 reduction in median direct costs and a $385 reduction in median indirect costs (P < 0.001).
  
  
  CONCLUSIONS
  Soft tissue infections requiring incision and drainage are common in the pediatric population, with the majority caused by methicillin-resistant Staphylococcus aureus. Infections requiring drainage most frequently occurred in the diaper area of girls younger than 3 years old. Changing to an MI technique significantly decreased the hospital costs and LOS in our patient population.
authors.affiliation: From the General Surgery Residency Program, the College of Medicine, and the Departments of Physics and Surgery, University of Kentucky, Lexington.
authors.forename: Tiffany N
authors.initials: TN
authors.lastname: Wright
authors.forename: Leah
authors.initials: L
authors.lastname: Gilligan
authors.forename: Oksana
authors.initials: O
authors.lastname: Zhurbich
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Davenport
authors.forename: John M
authors.initials: JM
authors.lastname: Draus
mesh_terms: D000038:Abscess / Q000191:economics / Q000601:surgery*; D002675:Child, Preschool; D004322:Drainage / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D012189:Retrospective Studies; D017192:Skin Diseases, Bacterial / Q000191:economics / Q000601:surgery*; D018461:Soft Tissue Infections / Q000191:economics / Q000601:surgery; D013207:Staphylococcal Skin Infections / Q000191:economics / Q000601:surgery