title: Multicentre observational study of outcomes after drainage of acute perianal abscess.
abstract: BACKGROUND
  Management of perianal abscesses has remained largely unchanged for over 50 years. The evidence for postoperative wound packing is limited and may expose patients to painful procedures with no clinical benefit and at considerable increased cost.
  
  
  METHODS
  Patients were recruited in 15 UK centres between December 2013 and October 2014. Outcome measures included number of dressing (pack) changes, healing, recurrence, return to work/normal function, postoperative fistula in ano and health utility scores (EQ-5D™). Pain was measured before, during and after dressing change on a visual analogue scale.
  
  
  RESULTS
  Some 141 patients were recruited (median age 39 (range 18-86) years). The mean number of dressing changes in the first 3 weeks was 13 (range 0-21), equating to an annual cost to the National Health Service of €6 453 360 in England alone per annum. Some 43·8 per cent of wounds were healed by 8 weeks after surgery and 86 per cent of patients had returned to normal function. Some 7·6 per cent of abscesses had recurred and 26·7 per cent of patients developed a fistula in ano by 6 months following surgery. Patients reported a twofold to threefold increase in pain scores during and after dressing changes.
  
  
  CONCLUSIONS
  Recurrent abscess is rare and fistula occurs in one-quarter of the patients. Packing is painful and costly.
authors.affiliation: Departments of General Surgery, Manchester Royal Infirmary, Manchester, UK.
authors.forename: L
authors.initials: L
authors.lastname: Pearce
authors.affiliation: Departments of General Surgery, Manchester Royal Infirmary, Manchester, UK.
authors.forename: K
authors.initials: K
authors.lastname: Newton
authors.affiliation: Departments of General Surgery, University Hospital South Manchester, Manchester, UK.
authors.forename: S R
authors.initials: SR
authors.lastname: Smith
authors.affiliation: Departments of General Surgery, Salford Royal Hospital, Salford, UK.
authors.forename: P
authors.initials: P
authors.lastname: Barrow
authors.affiliation: Departments of General Surgery, Royal Blackburn Hospital, Blackburn, UK.
authors.forename: J
authors.initials: J
authors.lastname: Smith
authors.affiliation: Departments of General Surgery, Salford Royal Hospital, Salford, UK.
authors.forename: L
authors.initials: L
authors.lastname: Hancock
authors.affiliation: Departments of General Surgery, University Hospital South Manchester, Manchester, UK.|Departments of General Surgery, Institute of Cancer Sciences, University of Manchester, Manchester, UK.
authors.forename: C C
authors.initials: CC
authors.lastname: Kirwan
authors.affiliation: Departments of General Surgery, Manchester Royal Infirmary, Manchester, UK.
authors.forename: J
authors.initials: J
authors.lastname: Hill
mesh_terms: D000038:Abscess / Q000191:economics / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001004:Anus Diseases / Q000191:economics / Q000628:therapy*; D001458:Bandages / Q000191:economics / Q000706:statistics & numerical data; D003152:Community Health Nursing / Q000191:economics; D004322:Drainage; D005260:Female; D005401:Fissure in Ano / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012008:Recurrence; D006113:United Kingdom; D064232:Visual Analog Scale; D014945:Wound Healing; D055815:Young Adult