O2201: Surgical drainage of perianal abscesses in infants is associated with higher rates of fistula development

Background: The ideal management of perianal abscesses in infants is controversial. Although some data supports non-operative management, many surgeons routinely drain abscesses despite adult literature demonstrating a potential association between surgical drainage and fistula formation. We sought to clarify the risk of fistula formation after surgical drainage of perianal abscesses in infants.

Methods: Infants ( < 1 year of age) who were diagnosed with their first perianal abscess between 2010 and 2023 were identified by ICD-10-CM codes in the PearlDiver Mariner database. The association between surgical drainage and fistula formation as well as need for surgical fistulotomy were compared using Kaplan-Meier analysis and Cox proportional hazards regression modeling.

Results: A total of 5522 infants were identified, of which 1081 (19.6%) underwent surgical drainage, 1190 (21.6%) developed a perianal fistula, and 876 (15.9%) underwent surgical fistulotomies within a year. Infants who had surgical drainage of an abscess compared to those who did not had higher rates of fistula development (36.4% vs 17.9%, p < 0.001) and need for surgical fistulotomy (29.7% vs 12.5%, p < 0.001). After adjusting for gender, Medicaid enrollment, and inpatient status, the risk of developing a fistula (hazard ratio [HR]: 2.09, 95% confidence interval [CI]: 1.85, 2.36) and undergoing surgical fistulotomy (HR: 2.09, 95% CI: 2.12, 2.80) remained significantly associated with surgical drainage of the abscess at initial presentation (Table 1 and Figure 1).

Conclusion: Infants with perianal abscesses that are surgically drained are more than twice as likely to develop a fistula or undergo surgical fistulotomy within one year. Non-operative management may result in lower rates of fistula development and lead to fewer procedures.