Wright Tiffany N, Gilligan Leah, Zhurbich Oksana, Davenport Daniel L, Draus John M
From the General Surgery Residency Program, the College of Medicine, and the Departments of Physics and Surgery, University of Kentucky, Lexington.
South Med J. 2013 Dec;106(12):689-92. doi: 10.1097/SMJ.0000000000000032.
We compared outcomes among pediatric patients managed with minimally invasive (MI) packing techniques with those managed with traditional packing techniques for drainage of subcutaneous abscesses.
After institutional review board approval, medical records of children requiring drainage of subcutaneous abscesses between January 2010 and June 2011 were reviewed. Data were collected on patient demographics, abscess location, surgical procedure, microbiology cultures, and hospital length of stay (LOS). The hospital accounting system was queried for direct and indirect costs. We compared LOS and cost data among groups managed with MI versus traditional packing techniques.
Incision and drainage was performed on 329 children (57.8% girls, 72% white, mean age of 43 months [range <1 to 218]). Of the total abscesses 198 (60.2%) were located in the groin/buttocks/perineum. Methicillin-resistant Staphylococcus aureus was identified in 74% of culture specimens. A total of 202 patients (61.4%) underwent packing and 127 (38.6%) underwent MI drainage. MI drainage ranged from 0% (0/110) in January to June 2010 to 34.6% (44/127) in the July to December 2010 transition period and reached 90.2% (83/92) in 2011 (P < 0.001). Median LOS decreased from 2 days (interquartile range 1-2) in the packing-only period to 1 day (interquartile range 1-2) in the predominantly MI period (P < 0.001). Hospital costs decreased with the transition to the MI technique (P < 0.001). MI drainage was associated with a $520 reduction in median direct costs and a $385 reduction in median indirect costs (P < 0.001).
Soft tissue infections requiring incision and drainage are common in the pediatric population, with the majority caused by methicillin-resistant Staphylococcus aureus. Infections requiring drainage most frequently occurred in the diaper area of girls younger than 3 years old. Changing to an MI technique significantly decreased the hospital costs and LOS in our patient population.
我们比较了采用微创（MI）填塞技术治疗皮下脓肿的儿科患者与采用传统填塞技术治疗的患者的治疗结果。
经机构审查委员会批准后，回顾了2010年1月至2011年6月期间需要进行皮下脓肿引流的儿童的病历。收集了患者人口统计学、脓肿位置、手术程序、微生物培养结果以及住院时间（LOS）等数据。查询医院会计系统以获取直接和间接成本。我们比较了采用MI技术与传统填塞技术治疗的组之间的住院时间和成本数据。
对329名儿童进行了切开引流（女孩占57.8%，白人占72%，平均年龄43个月[范围<1至218个月]）。在所有脓肿中，198个（60.2%）位于腹股沟/臀部/会阴区。74%的培养标本中鉴定出耐甲氧西林金黄色葡萄球菌。共有202例患者（61.4%）接受了填塞治疗，127例（38.6%）接受了MI引流。MI引流从2010年1月至6月的0%（0/110）增加到2010年7月至12月过渡期的34.6%（44/127），并在2011年达到90.2%（83/92）（P<0.001）。中位住院时间从仅采用填塞技术时期的2天（四分位间距1 - 2天）降至主要采用MI技术时期的1天（四分位间距1 - 2天）（P<0.001）。随着向MI技术的转变，医院成本降低（P<0.001）。MI引流使中位直接成本降低520美元，中位间接成本降低385美元（P<0.001）。
需要切开引流的软组织感染在儿科人群中很常见，大多数由耐甲氧西林金黄色葡萄球菌引起。需要引流的感染最常发生在3岁以下女孩的尿布区。在我们的患者群体中，改用MI技术显著降低了医院成本和住院时间。
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