EGS P07 Management of cutaneous abscesses using the Green Whistle: A Pilot Study
Authors: Poolovadoo Yanish , Laing Richard , Ghassemi Nader , Dawson Julian 
Published: December 2022

Background

Cutaneous abscesses form a significant volume of emergency general surgery operating throughout the UK. They are most commonly managed with an ‘incision and drainage’ (I&D) procedure which tends to be performed with a general anaesthetic (GA). As expected with the unpredictable nature of emergency general surgery, abscesses booked for I&D under GA are often delayed to accommodate a more urgent procedure or unwell patient. Costs and theatre utilisation of abscesses managed under a general anaesthetic were obtained and analysed. A pilot study was then designed to utilise Methoxyflurane (Penthrox/Green Whistle) as an alternative to general anaesthetic for the management of abscesses.

Methods

Retrospective data of patients requiring I&D of abscesses under GA between January 2020 and January 2021 was collected. Length of stay (LOS), length of surgery (entry into theatre to out of theatre), time spent in theatre (anaesthetic room and operating theatre) and theatre complex (holding bay, anaesthetic room, operating theatre and recovery) were collected. Financial costs were also obtained. Abscesses were organised into different degrees of complexity: complex, medium and simple. ‘Simple’ abscesses were defined as such if the patient met the following criteria: &gt;18 years, ASA 2 or less, non-perianal or ischiorectal and a surgical time of 10 minutes or less.

Following the results, a pilot study was designed and proposed.

20 patients were recruited to this pilot study. Recruitment was performed on admission via the emergency portal (surgical assessment unit). To be eligible for this study, patients would need to meet the following criteria:

A patient satisfaction survey was conducted via telephone at a later date.

Results

381 patients underwent an I&D under GA. Ratio of M:F was 1.12:1. Majority of abscesses drained were perianal (n=120) and pilonidal (n=81). Majority of patients were ASA 1 or 2. 100 ‘simple’ abscesses were identified. The sum of length of stay (LOS) was 949 days. The sum of surgery time (ST) was 4.6 days. The sum of total theatre time (TT) was 14 days. The sum of time in theatre complex (TC) was 48 days.

‘Simple abscesses’ had a total LOS of 144 days, total ST of 12 hours, total TT of 69 hours and total TC of 12 days.

Pilot study: 20 patients had cutaneous abscesses drained between July and September 2021 with Penthrox. M:F ratio was 11:9. 19 patients underwent successful drainage of their abscesses whereas 1 procedure had to be abandoned due to pain. Abscess drainage was performed on the 1st day of presentation in 15 patients. There were no 30-day readmissions noted within this pilot group.

83.3% of respondents to the patient satisfaction survey rated their experience as ‘Very Good’.

Costing

Overall savings of £4,150 were calculated per patient.

Conclusions

This study aimed to look into the feasibility of a dedicated abscess pathway for patients meeting specific inclusion criteria. Overall, the results have shown that this is feasible and cost-effective. It reduces length of stay, waiting times and costs. Patients are usually discharged home the same day without any complications. Our data has shown that performing an I&D of an abscess under the Green Whistle pathway costs 30-times as less than the same abscess being managed under a GA in the theatre complex.

The pilot study has been ratified at management level and we are currently in the process of stocking Green Whistles in our Surgical Ambulatory Unit and we will shortly begin widespread training and use.