Update Course Rewind- Who to Send Home from the OR: Uncomplicated Buttock Abscess and I&D Part 1

Globalcast MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. Hello, Pediatric Surgery Family. I'm Cecilia Hijena, a research fellow from Cincinnati Children's Hospital Medical Center. Our 11th Annual Update Course in Pediatric Surgery was held this past August. In this session, the surgeons discussed in round table fashion, who can go home from the OR on the same day of the procedure. Today, we are talking about uncomplicated buttock abscess in I&D. All right, 2-year-old Buttock Abscess, fevers before, otherwise normal vital signs. You take to the OR and do an I&D? Who's doing them in the ER? Is the ER physicians or suture tech who's doing them? The surgeon with fair a little surgery resident would drain in the ED. We don't take to the OR. So why do you? ED or are you guys using ketamine or other sedation? I'm just curious. Yes, the ED can provide some sedation. Yeah. So let's go and pull the poll up. See what people do. Most surgeons would either send the patients home from the floor the same day or the following day. But what drives the surgeons to keep them overnight? Is it the need for continued antibiotics? It depends on the circumstance to the antibi- for antibiotics. If there's extensive cellulitis and induration, then I would keep them in the hospital with IV antibiotics. If you think you have adequate first control then they can go home. So I don't think this is a one size fits all. Could this be treated solely with antibiotics and not surgical drainage? There there was another category where this is small minority. I'm wondering if people treat this with antibiotic in less than 1-year-olds, that's what the colorectal surgeons are teaching us. Series of the kids less than one and that these will resolve. If you just intermittently treat them with antibiotics and won't require a surgical procedure and that if you actually operate on them, you make them more likely to then have a fistula that develop. So this could be a game-changing question he just asked. There are some surgeons who suggest that children aged one or two years of age could be treated with antibiotics and discharged home. Let's talk about our data here. This is a retrospective review of 3-month to 4-year-olds who had same-day discharge. They go home quickly and then the failure rate was 2.3% of 30 days and that's pretty much on par with historical data. And then the only thing that correlated with failure was a higher white blood cell count. So most patients who have an I&D, were sent home on the same day without a high rate of recurrence. The next study looks specifically at sending kids home without additional antibiotics. And only one treatment failure out of 92 patients. So I think you should feel pretty confident sending them home from the pack you without and again this excluding those with concern for spreading cellulitis. Pediatric surgeons from around the globe discussed the safety and incidence of same day discharge for uncomplicated buttock abscess and I&D. Nearly a third to half of surgeons are already sending their patients home on the same day. Setting expectations with the family prior to the procedure has helped with acceptance of same day discharges. And there are very few patients who come back within 24 hours of procedure. Don't forget to subscribe to the Stay Current MD YouTube channel. Follow our social media channels and download the Stay Current MD app for tons of content in pediatric surgery. Globalcast MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.