Incision & drainage of perianal sepsis in the immunocompromised: A need for heightened postoperative awareness

Background: Incision and drainage of perianal sepsis has appreciable success in the immunocompetent population, but outcomes after incision and drainage in the immunosuppressed population are unknown. Methods: 13,666 patients (n = 930 immunosuppressed) undergoing incision and drainage of perianal sepsis between 2011 and 2015 in the American College of Surgeons National Surgical Quality Improvement Program were identified. The main outcomes were major morbidity, return to the operating room, and mortality. Multivariable analysis was performed for each outcome. Results: Sepsis was the most common postoperative complication. Preoperative immunosuppression was an independent risk factor for major morbidity (odds ratio [OR]: 1.6, p < 0.01), return to the operating room (OR: 1.9, p < 0.01), and mortality (OR: 2.6, p < 0.01). Conclusions: Immunosuppression is an independent risk factor for major morbidity, return to the operating room, and mortality. With post-operative sepsis the most common complication, inpatient admission and extended duration antibiotic therapy is warranted in immunosuppressed patients.