1. Socioeconomic Cost of Elective Surgery for Pilonidal Disease in a District General Hospital
Emily Decker1, Ania Mejsak1, Alan Askari2, Shirley Chan1
Departments of Surgery, Medway Maritime Hospital1 & Ipswich Hospital2, UK
INTRODUCTION
AIM
To assess the disease burden and socioeconomic cost of definitive treatment of pilonidal disease and potential savings with use of 10% metronidazole treatment in our district general hospital.
Pilonidal disease affects 18,000 people annually. Surgery risks non healing and recurrence (5-9%1) Topical 10% Metronidazole ointment (Ortem, SLA Pharma) may provide an alternative cost effective treatment.
METHOD
Patients admitted for elective pilonidal surgery were identified from hospital data for 2012 to 2016 inclusive. Patient demographics, treatment, readmissions, sick days and admission costs were calculated.
RESULTS
Final outcomes
2 patients with non-healing wounds
1 referred to tertiary unit for further treatment
Recurrent surgery in 21 patients (18%)
18 re-excision and primary closure
4 lay open
7 rhomboid flaps
Complications in 26 patients (22%)
5 patients underwent non operative treatment with antibiotics patient treated with 10% metronidazole ointment
All 5 patients’ wounds healed
Primary Procedure
83 (72%) excision and primary closure
19 (16%) lay open
14 (12%) rhomboid flaps
Demographics
116 patients – 93 male (80%)
Median age 28 years (range: years)
37 (32%) had previous abscess drainage before referral for elective surgery
Socio-economic cost per patient
Initial consultation: £201.17
Procedure cost – simple excision £927.00
– flap £
Follow up consultation £121.02
Median sick days following surgery 10 days
Cost per day to the economy3 £770.00
Average cost per patient: £11,439.00
Role of 10% Metronidazole ointment
Shown healing rate of 80% in non healing wounds1
Cost per unit £160.00
Socio economic cost of £294,046.00
subsequent operations
Predicted saving £226,393.28 !
21 patients required 29 additional operations (Range 1-4)
10% metronidazole ointment (Ortem, SLA Pharma UK)
DISCUSSION / CONCLUSION
REFERENCES
22 (19%) patients required >1 surgical procedure
Topical 10% metronidazole has been shown to have an % healing rate in patients with non-healing wounds2
If first line surgery fails, 10% metronidazole ointment may be an effective, acceptable and cost effective alternative to further surgery in these patients
Sullivan D. Management of Intergluteal Pilonidal Disease. In: UpToDate, Chen, W (ed), UpToDate, Waltham, MA, 2017
Ypsilantis et al. The use of topical 10% metronidazole in the treatment of non-healing pilonidal sinus wounds after surgery. Int J Colorectal Dis 2016;31(3):765-7
Office for National Statistics