SP10.12 Would You Like a Pus Swab Sent?Gita Lingam, Kylin Hu, Aarondeep Pamma, Naveed Kirmani
The Association of Coloproctology of Great Britain and Ireland (ACPGBI) consensus guidelines in emergency colorectal surgery states that microbiology sampling is of limited value in the management of anorectal abscesses. Several centres continue to send intra-operative swabs routinely for microbiology. This study aims to identify (1) if sampling changed postoperative management and (2) quantify the financial cost of sending unnecessary swabs within a district general hospital setting.
Retrospective study investigating intraoperative clinician use of microbiology swabs. Study sample included patients who underwent an incision and drainage of an anorectal abscess from 1st October 2021 to 1st October 2022 in a district general hospital setting.
A review of patient data obtained 59 patients who underwent an incision and drainage of an anorectal abscess. Swabs were taken in 54 (91.5%) cases. At 2 months, 40.7% of the swab results had not been reviewed by a clinician. 89% of swab results were reported after the patient was discharged. No documentation mentioned reviewing microbiology results in a follow-up clinic. There was no documented change of antibiotics nor correlation found between swab results and magnetic resonance imaging (MRI) requests/findings. Each microbiology swab costs £3 and labour costs are a minimum of £10 per swab analysed by a band 6 biomedical scientist. Total cost incurred per year was therefore estimated at £702.
Surgeons tend not to review microbiology results at follow-up appointments. Furthermore, there was no evidence that microbiology sampling resulted in change in patient management. Unnecessary use of swabs contributes to the NHS economic burden with no additional clinical benefit.