Bedside Drainage of Perianal Abscesses: Is It Safe and Effective?

Background: Perianal abscesses require immediate incision and drainage (l&D). However, prompt bedside drainage is controversial as it may compromise exposure and thorough anal examination. Objectives: To examine outcomes of bedside l&D of perianal abscesses in the emergency department (ED) vs. the operating room (OR). Methods: We conducted a retrospective review of all patients presented to the ED with a perianal abscesses between January 2018 and March 2020. Patients with Crohn's disease, horseshoe or recurrent abscesses were excluded. Results: The study comprised 248 patients; 151 (60.89%) underwent l&D in the OR and 97 (39.11%) in the ED. Patients elected to bedside l&D had smaller abscess sizes (P = 0.01), presented with no fever, and had lower rates of inflammatory markers. The interval time from diagnosis to intervention was significantly shorter among the bedside l&D group 2.13 ± 2.34 hours vs. 10.41 ± 8.48 hours (P< 0.001). Of patients who underwent l&D in the OR, 7.3% had synchronous fistulas, whereas none at bedside had (P = 0.007). At median follow-up of 24 months, recurrence rate of abscess and fistula formation in patients treated in the ED were 11.3% and 6.2%, respectively, vs. 19.9% and 15.23% (P = 0.023, 0.006). Fever (OR 5.71, P = 0.005) and abscess size (OR 1.7, P= 0.026) at initial presentation were risk factors for late fistula formation. Conclusions: Bedside l&D significantly shortens waiting time and does not increase the rates of long-term complications in patients with small primary perianal abscesses.