Factors influencing drainage setting and cost for cutaneous abscesses among pediatric patients

Am J Emerg Med. 2017 Feb;35(2):326-328. doi: 10.1016/j.ajem.2016.10.031. Epub 2016 Oct 17.


Objective: To evaluate the clinical and microbiological factors associated with skin and soft tissue infections drained in the emergency department (ED) vs operative drainage (OD) in a tertiary care children's hospital.

Methods: This was a cross-sectional study among children aged 2 months to 17 years who required incision and drainage (I&D). Demographic information, signs and symptoms, abscess size and location, and wound culture/susceptibility were recorded. Patient-specific charges were collected from the billing database. Multivariate regression analysis was used to determine factors determining setting for I&D and the effect of abscess drainage location on cost.

Results: Of 335 abscesses, 241 (71.9%) were drained in the ED. OD for abscesses was favored in children with prior history of abscess (odds ratio [OR], 3.18; 95% confidence interval [CI], 1.36-7.44; P = .01) and labial location (OR, 37.81; 95% CI, 8.12-176.03; P < .001). For every 1-cm increase in size, there was approximately a 26% increase in the odds of having OD (OR, 1.26; 95% CI, 1.11-1.44, P < .001). Methicillin-resistant Staphylococcus aureus was identified in 72% of the 300 abscesses cultured and 12.3% were clindamycin resistant. OD was more expensive than I&D in the ED. Per abscess that underwent I&D, OD is $3804.29 more expensive than I&D in the ED while controlling for length of stay.

Discussion: Clinical factors associated with OD rather than I&D in the ED included history of abscess, increased abscess length, and labial location. Microbiological factors did not differ based on I&D setting. For smaller, nonlabial abscesses, ED drainage may result in significant cost savings.

Publication types

  • Comparative Study

MeSH terms

  • Abscess / economics
  • Abscess / surgery*
  • Adolescent
  • Child
  • Child, Preschool
  • Costs and Cost Analysis
  • Cross-Sectional Studies
  • Dermatologic Surgical Procedures / economics
  • Dermatologic Surgical Procedures / methods*
  • Dermatologic Surgical Procedures / statistics & numerical data
  • Female
  • Hospitals, Pediatric / economics
  • Hospitals, Pediatric / statistics & numerical data
  • Hospitals, Urban / economics
  • Hospitals, Urban / statistics & numerical data
  • Humans
  • Infant
  • Male
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification
  • Multivariate Analysis
  • Pediatric Emergency Medicine / economics
  • Pediatric Emergency Medicine / methods
  • Pediatric Emergency Medicine / statistics & numerical data
  • Retrospective Studies
  • Skin Diseases, Infectious / economics
  • Skin Diseases, Infectious / surgery*
  • Soft Tissue Infections / economics
  • Soft Tissue Infections / surgery*
  • Staphylococcal Infections / economics
  • Staphylococcal Infections / surgery*
  • Statistics, Nonparametric
  • Suction / economics
  • Suction / methods