Safety and efficacy of a surgical ambulatory care pathway for superficial abscesses.

Abstract

Background: Superficial abscess of the skin is a common emergency presentation often requiring surgical management. Ambulatory Care Pathways (ACPs) are a method that can reduce the burden of this disease on hospital bed pressure by treating patients with superficial abscesses as day cases. We conducted a prospective cohort study to assess the safety and effectiveness of an ACP for patients meeting strict criteria with a superficial abscess.

Methods: Data on a new ACP for the management of superficial abscesses was collected for 12 months from June 20th, 2021 and compared to a retrospective control cohort of patients managed on an inpatient care pathway. Primary outcomes were length of inpatient stay and cost of admission, secondary outcomes were delays to theatre, complications, hospital or theatre readmission within 30 days.

Results: In total, 151 patient presentations were assessed, 79 in the ACP and 72 in the retrospective cohort. The mean age in our retrospective cohort was 36.3 ± 14.2 years, which was similar to our ACP cohort at 33.2 ± 12.5 (P = 0.16). Both cohorts had similar patient demographics. Inpatient bed days were significantly shorter for ACP patients with a median of 0.30 (IQR 0.20-0.95) days, compared to 1.53 (IQR 1.06-1.70) days for the retrospective cohort (P < 0.001). Both corhorts had similar postoperative complication rates (P > 0.4).

Conclusion: Managing selected patients who present out of hours with a superficial abscess using an ambulatory care pathway reduced cumulative inpatient length of stay and resulted in no increase in patient morbidity.