EP172 - Early Experience in Implementation of Postoperative Antibiotics following Anorectal Abscess Drainage: A Multi-Center Plan-Do-Study-Act Trial

Purpose/Background: Anorectal abscess is a common surgical disease with the gold standard of management requiring prompt incision and drainage. Antibiotics are selectively prescribed following abscess drainage; however, emerging evidence suggests postprocedural antibiotics may have a protective benefit in prevention of anorectal fistula. Despite this evidence, translation of evolving scientific knowledge into clinical practice is a challenging process often taking multiple years prior to successful implementation. The Plan-Do-Study-Act (PDSA) framework is a study tool that can measure application of new practice protocols as well as identify barriers to implementation. In the current study, we aim to improve the antibiotic prescription rate following anorectal abscess drainage by employing the PDSA model to measure pre- and post-protocol prescription rates and identify barriers to the implementation of a new practice protocol.

Methods/Interventions: This is a multi-center prospective observational study involving patients receiving anorectal abscess drainage between 1/1/23-12/31/26. Baseline characteristics including demographic, comorbidities, and antibiotic regimens were collected for all study participants. All patients undergoing anorectal abscess drainage between 1/23-6/25 were retrospectively reviewed for antibiotic prescription rate. On 7/1/25, a new practice protocol was instituted whereby all patients were to receive a 7-day course of antibiotics following anorectal abscess drainage. Monthly assessments were completed to identify both the success of and barriers to protocol implementation, as part of the PDSA model. The primary outcome was the comparison of pre- and post- protocol antibiotic prescription difference with secondary outcomes including provider compliance with the new protocol.

Results/Outcomes: The study cohort included 560 participants, 536 were reviewed prior to protocol initiation and 24 were followed after protocol initiation. The average age of the cohort was 43 (+/-15.7) years. The majority were men (77%) and Caucasian (48%). Baseline antibiotic prescription rate prior to protocol initiation was 63% with amoxicillin/clavulanate the most common prescription (76%) for median [IQR] duration of 8 [6-10] days. After protocol initiation, antibiotic prescription rates improved to 95% with levofloxacin/metronidazole becoming the most prescribed antibiotics (55%) with median 8 [6-10] day duration. At the time of our consensus group discussion, we found that presentations at staff meetings as well as creation of electronic medical record (EMR) documentation templates and guideline posters were impactful in the protocol implementation.

Conclusion/Discussion: This is an ongoing mixed methods study utilizing the PDSA model to investigate the implementation of a postprocedural protocol for antibiotic prescription following incision and drainage of anorectal abscesses. During the first interim assessments, it was determined that the new protocol had 95% compliance. This surpassed our set goal of 80% compliance at this first checkpoint. The recency of the introduction coupled with multiple presentations on the protocol likely resulted in the early application success. Future direction aims to continue monthly assessment of the protocol progression and identify the barriers to effective implementation.

Table 1: Demographics and Comorbid Conditions
Demographic and comorbid conditions of study population with separation based on antibiotic prescription
Figure 1: PDSA Cycle
Outline of our proposed PDSA cycle for measuring the implementation of the new practice protocol