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Optimizing Anorectal Abscess Treatment: Cutting Costs and Enhancing Sustainability through Smarter Swab Use

Jefferson George1,2, Indhu Poomalai2, Amuthan J2, Antony Joe J3

1The Shrewsbury and Telford Hospital NHS Trust, Shrewsbury, United Kingdom. 2Madurai Medical College and Government Rajaji Hospital, Madurai, India. 3Joe Hospital, Nagercoil, India


Introduction: Microbiological sampling has a minimal impact in managing anorectal abscesses according to the Consensus Guidelines for Emergency Colorectal Surgery by ACPGBI. Despite this, many centres continue to routinely send pus swabs for analysis, even though they do not alter postoperative management. This QI project aimed to assess and minimize pus-swab utilization during anorectal abscess treatment to support sustainable healthcare and reduce financial costs.

Method: The QI project was completed in an Indian tertiary care hospital. The study included patients who underwent incision and drainage of an anorectal abscess between February 1, 2021, and June 1, 2021, in the first cycle, and between July 1, 2021, and November 1, 2021, in the second cycle after implementing changes.

Results: In the first cycle, data from 67 patients revealed that swabs were taken in 58 (86.5%) cases. Follow-up data showed that 71% of swab results were not reviewed, and no documented change in antibiotics or management followed the microbiology report. Each swab incurred a cost of 200 INR, with labor costs of at least 300 INR per swab. The total cost over four months was estimated at 29,000 INR (290 GBP). In the second cycle, eight swabs were sent from 73 patients, indirectly saving the hospital around 27,575 INR (275 GBP).

Conclusions: Microbiological findings are not reviewed at follow-up consultations, and these results have no impact on patient management. This QI project showcased a straightforward method to decrease healthcare's economic burden without compromising clinical benefits.