Management of adult superficial acute abscesses in a tertiary hospital: time for incisive action.

AIM

Reduction in length of inpatient stay is an important factor in reducing healthcare costs in many hospital systems. This paper examines trends in hospital stay over time for general surgical patients presenting with abscess, and outlines the potential benefits if a day case service for acute abscess procedures was established.

METHOD

Retrospective review of Otago Surgical Audit data from 1992 to 2007 yielded clinical data for 2475 adult general surgical cases at Auckland City Hospital with a primary or secondary diagnosis of abscess. A subset of patients potentially suitable for day case surgical procedures was analysed.

RESULTS

A steady increase in numbers of abscess cases treated by the Department of General Surgery was seen from 1992 to 2007. The most common types of superficial abscess were cutaneous (47%), perianal (40%), and breast (13%). Fifty-nine percent of general surgical hospital admissions in this series could potentially have been treated on a day case basis, but only 6% were actually treated as day cases. A median duration of inpatient stay of two days was required for a mean procedure duration of 16 minutes. A total of 1357 (90%) patients had a total hospital stay of more than 24 hours in the potential day case group. This accounted for 2338 bed days over the 15-year study period, or an average of 359 bed days per annum. For the most recent three-year period, the average total cost of each acute superficial abscess admission for less than seven days was $4440. The average cost for a patient treated as a day case was $1389, indicating a potential saving of $3501 per patient if a day case service had been available.

CONCLUSION

This study identifies a common problem which is being managed suboptimally in our hospital. Day case management of appropriate patients with acute superficial abscess would result in significant cost savings, decrease hospital bed occupancy and improve patient care.