Abstract：
BACKGROUND: Acute surgical units (ASU) are increasingly being adopted and in our system are staffed by colorectal and non-colorectal general surgeons. This study aims to evaluate whether surgeon specialization was associated with improved outcomes in perianal abscess.
METHODS: Patients with perianal abscess admitted to the ASU between 2016 and 2020 were identified from a prospective database and their medical records reviewed. Patients with IBD, treatment for fistula-in-ano within the preceding year, or perianal sepsis of non-cryptoglandular origin were excluded. Patients admitted under an ASU colorectal (CR) consultant were compared with those under a non-CR general surgeon in a retrospective cohort study. Primary outcome was perianal abscess recurrence. For those without initial fistula, hazard of recurrent abscess or fistula was analysed. Multivariable Cox PH regression analysis was performed.
RESULTS: Four-hundred and eight patients were included (150 CR, 258 non-CR). The CR group more frequently had a fistula identified at index operation (34.0% versus 10.9%, P < 0.0001). However, Cox multivariable analysis found no difference in hazard of recurrent abscess between groups (HR 1.12, 95% CI 0.65-1.95, P = 0.681)). Abscess recurred in 18.7% CR and 15.5% non-CR. Subsequent fistula developed in 14.7% in both groups. For patients without initial fistula, there was no difference between groups in hazard of recurrent abscess or fistula (HR 1.18, 95% CI 0.69-2.01, P = 0.539).
CONCLUSIONS: Surgeon specialization was not associated with improved outcomes for ASU patients with perianal abscess, albeit with potential selection bias. CR surgeons were more proactive identifying fistulas; this raises the possibility that drainage alone may be adequate treatment.
METHODS: Patients with perianal abscess admitted to the ASU between 2016 and 2020 were identified from a prospective database and their medical records reviewed. Patients with IBD, treatment for fistula-in-ano within the preceding year, or perianal sepsis of non-cryptoglandular origin were excluded. Patients admitted under an ASU colorectal (CR) consultant were compared with those under a non-CR general surgeon in a retrospective cohort study. Primary outcome was perianal abscess recurrence. For those without initial fistula, hazard of recurrent abscess or fistula was analysed. Multivariable Cox PH regression analysis was performed.
RESULTS: Four-hundred and eight patients were included (150 CR, 258 non-CR). The CR group more frequently had a fistula identified at index operation (34.0% versus 10.9%, P < 0.0001). However, Cox multivariable analysis found no difference in hazard of recurrent abscess between groups (HR 1.12, 95% CI 0.65-1.95, P = 0.681)). Abscess recurred in 18.7% CR and 15.5% non-CR. Subsequent fistula developed in 14.7% in both groups. For patients without initial fistula, there was no difference between groups in hazard of recurrent abscess or fistula (HR 1.18, 95% CI 0.69-2.01, P = 0.539).
CONCLUSIONS: Surgeon specialization was not associated with improved outcomes for ASU patients with perianal abscess, albeit with potential selection bias. CR surgeons were more proactive identifying fistulas; this raises the possibility that drainage alone may be adequate treatment.
摘要：
背景：急性外科单元（ASU）越来越多地被采用，在我们的系统中，由结直肠和非结直肠的普通外科医生组成。这项研究旨在评估外科医生的专业化是否与肛周脓肿的预后改善有关。
方法：从前瞻性数据库中确定了2016年至2020年期间进入ASU的肛周脓肿患者，并回顾了他们的病历。IBD患者,在前一年内治疗瘘管，或非隐腺起源的肛周脓毒症被排除在外.在一项回顾性队列研究中，将接受ASU结直肠（CR）顾问治疗的患者与非CR普通外科医生治疗的患者进行了比较。主要结果是肛周脓肿复发。对于那些没有初始瘘管的人，对复发性脓肿或瘘管的危害进行了分析。进行多变量CoxPH回归分析。
结果：纳入了四百零八例患者（150例CR，258非CR）。CR组更频繁地在索引手术中发现瘘管(34.0%对10.9%,P<0.0001)。然而,Cox多变量分析发现两组之间复发性脓肿的风险无差异（HR1.12，95％CI0.65-1.95，P=0.681）。脓肿复发的CR为18.7％，非CR为15.5％。两组术后瘘发生率为14.7%。对于没有初始瘘管的患者，复发性脓肿或瘘的风险组间无差异(HR1.18,95%CI0.69-2.01,P=0.539)。
结论：外科医生专业化与ASU肛周脓肿患者预后改善无关，尽管有潜在的选择偏见。CR外科医生更主动地识别瘘管；这增加了单独引流可能是适当治疗的可能性。
方法：从前瞻性数据库中确定了2016年至2020年期间进入ASU的肛周脓肿患者，并回顾了他们的病历。IBD患者,在前一年内治疗瘘管，或非隐腺起源的肛周脓毒症被排除在外.在一项回顾性队列研究中，将接受ASU结直肠（CR）顾问治疗的患者与非CR普通外科医生治疗的患者进行了比较。主要结果是肛周脓肿复发。对于那些没有初始瘘管的人，对复发性脓肿或瘘管的危害进行了分析。进行多变量CoxPH回归分析。
结果：纳入了四百零八例患者（150例CR，258非CR）。CR组更频繁地在索引手术中发现瘘管(34.0%对10.9%,P<0.0001)。然而,Cox多变量分析发现两组之间复发性脓肿的风险无差异（HR1.12，95％CI0.65-1.95，P=0.681）。脓肿复发的CR为18.7％，非CR为15.5％。两组术后瘘发生率为14.7%。对于没有初始瘘管的患者，复发性脓肿或瘘的风险组间无差异(HR1.18,95%CI0.69-2.01,P=0.539)。
结论：外科医生专业化与ASU肛周脓肿患者预后改善无关，尽管有潜在的选择偏见。CR外科医生更主动地识别瘘管；这增加了单独引流可能是适当治疗的可能性。
