Medical Specialties Commons^™

Comparison Of Pharmacological, Endoscopic, And Interventional Strategies For Primary And Secondary Prophylaxis Of Variceal Bleeding: A Systematic Review And Network Meta-Analysis Of Randomized Controlled Trials, Mujtaba Moazzam, Hasnain Saqib, Rehman Bashir, Talha Khan, Mahad Ahmed, Marjan Haider, Michael Fine

Conference Presentation Abstracts

Background: Gastroesophageal variceal bleeding carries significant morbidity and mortality in patients with portal hypertension. Multiple pharmacological, endoscopic, and interventional strategies have emerged for prophylaxis, yet no network meta-analysis has comprehensively compared the full treatment spectrum across both primary and secondary prophylaxis settings. We aimed to evaluate their relative efficacy within a single unified framework. Methods: We conducted a systematic review and frequentist random-effects NMA of RCTs comparing propranolol, nadolol, carvedilol, EBL, combination therapy (EBL plus beta-blocker), and TIPS. Databases searched included PubMed/MEDLINE, Embase, Cochrane CENTRAL, Scopus, and ClinicalTrials.gov through January 2026 (PROSPERO: CRD420261304355). Outcomes included bleeding/rebleeding risk and all-cause mortality. …

The Mash Resolution Index For Non-Invasive Detection And Monitoring Of Mash Resolution: A Systematic Review And Pooled Analysis, Rahul Falodia, Ehsanullah Alokozay, Muhammad Junaid Azhar, Farhan Murtaza, Abdullah Imtiaz, Hamza Farooq Khan, Muhammad Ahmad Imran, Miriam Michael, Bacel Nseir, Wehbi Hanayni, Anand Deonarine

Conference Presentation Abstracts

Background: The MASH Resolution Index (MASHResInd) is a novel non-invasive score comprising baseline MRI-proton density fat fraction (MRI-PDFF), percentage change in MRI-PDFF, baseline alanine aminotransferase (ALT), change in ALT, and baseline aspartate aminotransferase (AST), developed to detect histological resolution of metabolic dysfunction-associated steatohepatitis (MASH) without worsening fibrosis. Despite its development in 2024, no synthesis of its diagnostic performance, comparative accuracy, and responsiveness to intervention exists. This systematic review and pooled analysis aimed to comprehensively evaluate the evidence for MASHResInd across pharmacological and non-pharmacological intervention settings. Methods: A systematic search of PubMed, Embase, and Cochrane databases was conducted through May 2026 …

Nmr Metabolomics & Nmr-Metabolomics-Ai-Guided Trans-Omics Studies Of Human Acute Respiratory Distress Syndrome (Ards), Leo Cheng

Conference Presentation Abstracts

Targeted and untargeted NMR metabolomics, particularly by utilizing our previously invented high-resolution magic angle spinning (HRMAS) technique, can measure pathological tissues prior to their pathological evaluations, biological fluids (serum, CSF, etc.) in 10uL scales, and live cellsin the amount of < 100,000. Furthermore, NMR metabolomics results can be quantitatively correlated with other omics’ results measured from other platforms.

In this presentation, we will illustrate the super utilities of NMR metabolomicsin medicine, with a primary focus on discussions of our NMRmetabolomics-AI-guided trans-omics evaluations of Human Acute Respiratory Distress Syndrome (ARDS), a severe, life-threatening clinical condition and representing ~10% of all ICU patients in the US, but with its molecular and metabolic mechanisms remain incompletely understood.

To address this gap, …

The Power Of Proximity: Driving Hand Hygiene Compliance Through Sanitizer Placement, Jennifer E. Jones, Eric Van Middendorp, Leanne Wendt

Posters

Hand hygiene is the cornerstone of infection prevention in healthcare settings and is particularly critical in the Neonatal Intensive Care Unit (NICU) where patients are highly vulnerable due to immature immune systems and frequent exposure to invasive procedures. Healthcare associated infections (HAIs) remain a significant cause of morbidity and mortality among neonates. Evidence consistently identifies proper hand hygiene as the single most effective intervention to reduce HAIs in NICUs. Despite its simplicity, compliance among healthcare workers is often suboptimal, influenced by factors such as workload and accessibility of hand hygiene resources.

Quality In Action: A Systematic Approach To Central Line Associated Bloodstream Infection Prevention, Jennifer E. Jones, Maggie Simons, Sherri Hoard, Gabriel Laney, Adam Nicholson, Victoria Springvloed, Tracy James, Erica Tuffs

Posters

Central line associated bloodstream infections (CLABSIs) are a major source of morbidity, mortality, and increased healthcare costs in hospitalized patients. Reducing CLABSI rates requires more than isolated interventions; it demands a coordinated, multi-disciplinary strategy that addresses clinical practice, workflow and organizational culture.

Operation No Noro: A Multidisciplinary Approach To Containing A Norovirus Outbreak In An Inpatient Rehabilitation Unit, Donika Marko, Roula Hilli, Priscila Bercea, Pamela S. Bozigar, Levi Launder, Stephanie Robertson, Trini A. Mathew

Conference Presentation Abstracts

Norovirus is a highly contagious viral gastroenteritis and can rapidly spread in healthcare settings, particularly in congregate environments such as inpatient rehabilitation units. In March 2025, a cluster of acute gastrointestinal illness was identified on a 34-bed inpatient rehabilitation unit within a 150-bed acute care hospital. Eight patients developed: • Nausea • Vomiting • Diarrhea • Abdominal pain Due to shared spaces, communal therapy activities, and high patient interaction, rapid intervention was initiated to prevent further spread.

Proactive Strategies For Catheter-Associated Urinary Tract Infection (Cauti) Reduction: Leveraging Audit Tools And Interdisciplinary Collaboration, Mica Blauw

Posters

Catheter-associated urinary tract infections (CAUTIs) are a known cause of harm to patients. Policies enforcing infection prevention measures may help minimize the risk of harm to patients, but written policies do not always translate to bedside practice. We implemented a proactive daily audit to increase awareness of, and compliance with, CAUTI prevention tactics.

Code Wet: Navigating Water Leak Mitigation And Remediation Behind The Red Line, Mica Blauw

Posters

Water leaks in the hospital setting are concerning because of the possibility of mold growthon porous materials such asdrywallthatmaylead toinfections. Water leaksbehind the line of demarcation in the surgical services suiterequire extra care during the remediation processdue to the high-risk nature of surgical patients. We navigated water leakmitigation and remediation in a surgical suite while keeping surgical operations funning safely.

Comparative Analysis Of Fixed Versus Variable Rate Of Regional Citrate Anticoagulation In Critically Ill Ecmo Patients On Continuous Kidney Replacement Therapy, Lisa Hall Zimmerman, Alexander Chen, Felcia Ivascu, Anthony Iacco, Jimmi Mangla, Wesley Barnes, Sean Masters

Conference Presentation Abstracts

Background: Continuous kidney replacement therapy (CKRT) is the preferred dialysis modality for critically ill patients with hemodynamic instability. Anticoagulation is often necessary to deliver CKRT effectively and prolong the circuit lifespan. The Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guideline for acute kidney injury 2012 recommends regional citrate administration during CKRT for patients without contraindications to prevent filter clotting. Citrate works by chelating calcium and interfering with the activation of the coagulation cascade. This study evaluated effectiveness and safety of fixed (FIX) versus variable citrate rate (VAR) in critically ill patients receiving CKRT. Methods: This single-center, retrospective study evaluated …

Anatomy Of Teamwork: Leveraging Peer Feedback To Build A Bespoke Team Charter Assignment, Emily Tenniswood, Stefanie Attardi

Posters

Post-COVID-19, students in our M1 Anatomical Foundations of Clinical Practice (AFCP) courses increasingly request faculty guidance or intervention in managing intra-dissection team conflict.

Optimizing Patient-Facing Ai Chatbot Questions To Improve Readability And Actionability In Anesthesia Education, Sarah Kadado, Bianca Elias, Roy Soto

Posters

In anesthesia, high patient anxiety and limited counseling time increase the need for clear, usable information. Artificial intelligence (AI) chatbots (e.g., ChatGPT) are increasingly used for patient anesthesia education. Many AI-generated responses exceed the recommended 6th-8th grade reading level for patient education information. Responses also often lack actionable guidance for patients. This study quantifies how optimizing patient-facing prompts improves readability, understandability, and actionability.

Perceptions Of Radiology Residency Staffing Models Across Years Of Training, Alex Zhang, Alexander Swantek, Adela Pouzar, Sayf Al-Katib

Posters

Case staffing is the primary method by which radiology residencies teach at the workstation. Despite this, the styles and methods for how staffing is performed have not yet been comprehensively described. Understanding these models and evaluating resident perspectives can inform best practices and enhance radiology education.

Dnajb9-Positive Fibrillary Glomerulonephritis In A Patient With Longstanding Discoid Lupus Erythematosus: A Rare Association, Seyedah Simi Daryabari, Abhishek Vadhar, Sally Othman, Brahmani Tata, Towfiqul Chowdhury, Sujata Kambhatla, Chadi Saad

Conference Presentation Abstracts

Fibrillary glomerulonephritis (FGN) is a rare primary glomerular disease characterized by the organized deposition of nonamyloid, randomly arranged fibrils within the mesangium and glomerular basement membrane. While FGN is frequently associated with malignancies and chronic infections, its association with the autoimmune spectrum is emerging as a critical clinical entity. Specifically, the relationship between DNAJB9-positive FGN and discoid lupus erythematosus (DLE) is exceedingly rare, as renal manifestations in lupus patients are typically attributed to immune-complex-mediated lupus nephritis. We present the case of a 67-year-old female with a longstanding history of DLE, manifesting as cutaneous lesions on the extremities and scalp with …

Late Hepatitis B Reactivation After Hsct And B-Cell Depleting Therapy: Case Vignettes Challenging Fixed-Duration Prophylaxis, Ariana Cho, Harrison Moses, Muaz Alchirazi, Vishakh Keri, Lea Monday

Conference Presentation Abstracts

Hepatitis B virus (HBV) reactivation remains a critical concern in immunosuppressed oncology and hematopoietic stem cell transplant (HSCT) patients, yet the optimal duration of antiviral prophylaxis is unresolved. Current guidelines recommend 12–18 months of prophylaxis after HSCT or B-cell depleting therapy for patients who are isolated anti-HBc positive, based on documented cases of late reactivation beyond the traditional 12-month threshold. However, these recommendations largely derive from studies in HBsAg-positive patients or those receiving rituximab-containing regimens, with limited data addressing the broader range of high-risk scenarios encountered in practice. We present two vignettes highlighting this gap. Patient 1 is a 60-year-old …

Training Fm Residents In Prep Is "Hiv Possible", M Ellis Jaruzel, Carlie Nikel

Conference Presentation Abstracts

Pre-Exposure Prophylaxis (PrEP) offers the promise of dramatically reducing the risk of HIV transmission. Institutions in public health believe that PrEP is key to ending the HIV epidemic and improving access is central to this program. Prior literature has suggested that discomfort discussing sexual behaviors and STIs inhibit prescribing PrEP in primary care settings. Given the anticipated need for competent prescription of PrEP in primary care settings as a future routine part of clinical practice, a large (10/10/10) midwestern family medicine residency program designed and implemented a sexual health and PrEP OSCE in consultation with experts from the state (Michigan) …

Device And Patient-Related Complications Of Renal Denervation For Resistant Hypertension: A Post-Marketing Analysis Of The Fda Maude Database, Sai Tharun Reddy Gopannagari, Kesava Manikanta Achuta, Divya Ganisetti, Towfiqul Chowdhury, Chadi Saad

Conference Presentation Abstracts

Background: Renal denervation (RDN) has re-emerged as an adjunctive therapy for resistant hypertension following recent FDA approvals of ultrasound- and radiofrequency-based systems. While contemporary randomized trials report a favorable safety profile, real-world post-marketing data may capture a broader spectrum of complications. Methods: We queried the FDA Manufacturer and User Facility Device Experience (MAUDE) database from inception through December 22, 2025, using product code ‘QYI’ and brand names ‘Paradise’ (Recor Medical) and ‘Symplicity Spyral’ (Medtronic). Reports describing RDN procedures for resistant hypertension were included. Events were manually reviewed and categorized as vascular, device-related, hemodynamic/arrhythmic, neurologic, or other. When multiple events occurred …

Opioid-Free Hernia Repair Protocol Reduces Pediatric Opioid Exposure Without Compromising Pain Control, Abigail Teitelbaum, Kristin E. Lemarbe, Diane Studzinski, Corey Shafer, Antonela Muca, Emanuela Peshel, Randall Hilleary, Anthony Stallion, Nathan M. Novotny, Pavan Brahmamdam, Begum Akay

Conference Presentation Abstracts

Abstract: Purpose: Protocolizing perioperative pain management may reduce opioid exposure in children. We designed a multimodal pain management protocol for pediatric ambulatory hernia surgery with the goal of reducing opioid use. This study evaluates the impact of this protocol on opioid use, pain control, and patient/proxy satisfaction. Methods: Our protocol utilized child life services, regional anesthesia, and non-opioid analgesic adjuncts in the perioperative period. We reviewed all pediatric ambulatory hernia cases two years before and after protocol implementation. Protocol adherence was stratified by level of opioid use: high (no opioid use), medium (opioids used intraoperatively or postoperatively), and low adherence …

When Optimal Therapy Becomes High Risk: A Risk-Benefit Framework For Beta-Lactam Desensitization In Life-Threatening Mssa Infection, Rana Amoush, Aaron Kobernick

Conference Presentation Abstracts

Background Beta-lactam antibiotics are preferred for invasive methicillin-sensitive Staphylococcus aureus (MSSA) infections, especially those involving prosthetic material. Management is challenging in patients with severe beta-lactam hypersensitivity, as alternative agents may be less effective or poorly tolerated. Limited guidance exists on reassessing desensitization risk when second-line therapies become untenable. Purpose To present a case-based risk-benefit framework for evaluating beta-lactam desensitization in medically complex patients with life-threatening MSSA infections. Methods We retrospectively reviewed a patient with recurrent MSSA prosthetic graft infection and severe beta-lactam hypersensitivity. Clinical decision-making was analyzed using a structured risk–benefit framework incorporating infection severity, therapeutic superiority of beta-lactams, tolerance …

Two Glands, One Problem: Navigating Fertility Treatment In Concurrent Nonclassic Congenital Adrenal Hyperplasia And Polycystic Ovary Syndrome, Paul Meram, Mary Show, Elliott Gappy, Ajaz Banka

Conference Presentation Abstracts

Background: Nonclassic congenital adrenal hyperplasia (NCCAH) caused by 21-hydroxylase deficiency is generally a milder variant of congenital adrenal hyperplasia characterized by partial enzyme activity and variable increases in adrenal androgen levels. Patients presenting with such a condition may present in adolescence or adulthood with symptoms such as acne, hirsutism, irregular menses, and infertility. These symptoms often overlap with those of Polycystic Ovary Syndrome (PCOS), creating challenges in differentiation and management. It is critical to differentiate between PCOS and NCCAH in females of reproductive age, as hyperandrogenism treatment depends on the underlying cause, such as adrenal, ovarian, or a combination of …

Spontaneous Coronary Artery Dissection In Postpartum: A Hidden Cause Of Maternal Myocardial Infarction, Riya Chhabra, Brian Renard

Conference Presentation Abstracts

Spontaneous coronary artery dissection (SCAD) is a tear in the coronary artery lining which decreases blood flow to the heart. SCAD is the leading cause of myocardial infarction in young to middle aged women, especially during and after pregnancy. While SCAD is often managed conservatively, patients are prone to complications like cardiomyopathy. This case underscores the importance of considering SCAD as a differential for postpartum women with chest pain. Furthermore, this case highlights the diagnosis and management of an atypical stress-induced cardiomyopathy with global hypokinesis following postpartum SCAD. A 37-year-old female postpartum for five weeks presented to our hospital with …

Changes In Opioid Prescribing Patterns In Opioid Naive Patients Can Translate To Improved Outcomes In The Opioid Non-Naive Patients With Anterior Cervical Surgery: A Michigan Spine Surgery Improvement Collaborative (Mssic) Study, Anisse Chaker, Geoff Kahn, Michael Melhem, Jian-Hui Hu, Kari Jarabek, Heegook Yeo, Bhargav Ayloo, Trevor Ruesch, Adam Junn, Jad Khalil, Kenneth Easton, Richard Easton, Doris Tang, Miguelangelo Perez-Cruet, Noojan Kazemi, Ilyas Aleem, Muwaffak Abulhak, David Nerenz, Victor Chang

Conference Presentation Abstracts

Introduction: Though often necessary for adequate analgesia after spine surgery, continued opioid use can lead to chronic dependency. The Michigan Spine Surgery Improvement Collaborative (MSSIC) has demonstrated in prior work the promise of utilizing a multi-institutional morphine milliequivalent (MME) cutoff for elective anterior cervical surgery in the opioid naıve population. However, the effect of this cutoff in patients who were already on opioids pre-operatively have not previously been studied. The goal of this study was to evaluate whether changes in prescribing patterns in the opioid naıve population would also translate to the non-naıve populations, and whether the non-naıve population would …

Implementation Of A Multi-Institutional Enhanced Recovery After Surgery (Eras) For Elective Spine Surgery: Two-Year Michigan Spine Surgery Improvement Collaborative (Mssic) Experience, Anisse Chaker, Kylie Springer, Kari Jarabek, Michael Melhem, Heegook Yeo, Jian-Hui Hu, Jad Khalil, Kenneth Easton, Richard Easton, Doris Tong, Miguelangelo Perez-Cruet, Noojan Kazemi, Ilyas Aleem, Muwaffak Abulhak, Victor Chang

Conference Presentation Abstracts

Introduction: Enhanced Recovery After Surgery (ERAS) protocols have been introduced to several surgical specialties with the intention to reduce peri-operative adverse events and improve various health-system quality metrics including length of stay and patient satisfaction. Though this has been studied in the setting of spine surgery, the vast majority are single institution protocols biased toward academic teaching hospitals. There is a paucity of literature studying the utilization of a multi-institutional ERAS protocols that is applicable to community hospitals without associated training programs. We present the Michigan Spine Surgery Improvement Collaborative (MSSIC) two-year experience implementing a multi-institutional ERAS protocol for elective …

The Impact Of Covid-19 On Spine Surgery: Temporal Trends In Complications And Patient-Reported Outcomes Across A Statewide Cohort, Ali Mehaidli, Richard Easton, Ahmad Almaat, Gary George, Alqasim Elnaggar, Victor Chang, Doris Tong, Jad Khalil, Kevin Taliaferro

Conference Presentation Abstracts

Introduction: The COVID-19 pandemic caused major disruptions in elective surgical care, including spine surgery, due to widespread hospital restructuring and resource limitations. Although previous studies have examined surgical volumes and safety during the pandemic, limited data exist on how outcomes varied across multiple phases of the pandemic, especially in real-world, multicenter spine surgery populations. Material and Methods: This retrospective cohort study used data from the Michigan Spine Surgery Improvement Collaborative (MSSIC) to compare outcomes in patients undergoing lumbar or cervical spine surgery across four COVID-19 timeframes: pre-COVID (1/2019-2/2020), onset-COVID (3/2020-9/2020), active-COVID (10/2020-2/2022), and post-COVID (3/2022- 12/2022). Patient demographics, surgical characteristics, …

Halo Effect Of Prescribing Guidelines For Opioid Naive Patients Translates To Opioid Non-Naive Patients Undergoing Lumbar Decompression: A Michigan Spine Surgery Improvement Collaborative (Mssic) Study, Anisse Chaker, Geoff Kahn, Michael Melhem, Jian-Hui Hu, Kari Jarabek, Heegook Yeo, Jawad Saad, Abdullah Al-Tekreeti, Kenneth Easton, Jad Khalil, Richard Easton, Doirs Tong, Miguelangelo Perez-Cruet, Noojan Kazemi, Ilyas Aleem, Muwaffak Abulhak, David Nerenz, Victor Chang

Conference Presentation Abstracts

Introduction: Chronic opioid dependency in spine surgery is an ongoing concern given the ongoing opioid epidemic. We have previously reported on our cohort of opioid-naıve patients, however the literature has shown that patients with opioid use at baseline are at higher risk of less favorable outcomes. Starting in 2022, MSSIC instituted state-wide prescribing guidelines for opioid naıve patients undergoing one- or two-level lumbar decompression surgery (laminectomy, laminotomy, foraminotomy, microdiscectomy) with performance goals of 80% compliance. The goal of this study was to evaluate whether there would be a form of a “halo” effect on prescribing patterns for patients with baseline …

Postoperative Ileus After Lumbar Spine Surgery: Modifiable Risk Factors And Impact On Outcomes, Ali Mehaidli, Richard Easton, Alqasim Elnaggar, Gary George, Ahmad Almaat, Victor Chang, Jad Khalil, Kevin Taliaferro

Conference Presentation Abstracts

Introduction: Postoperative ileus (POI) is an infrequent but impactful complication following lumbar spine procedures. While well-characterized in abdominal surgery, spine-specific data remain limited, particularly regarding modifiable risk factors. Materials and Methods: We analyzed 41,164 patients who underwent elective lumbar spine surgery between 2018 and 2023 using the Michigan Spine Surgery Improvement Collaborative (MSSIC) registry. Multivariable generalized estimating equation models were used to identify independent risk factors for POI. We also evaluated the association between POI and postoperative outcomes, including patient-reported outcome measures (PROMs). Results: POI occurred in 1.1% of patients (n = 447). Independent risk factors included older age (RR …

Significantly Elevated Procalcitonin In Aki Reliable Or Not Reliable?, Sally Othman, Sujata Kambhatla, Chadi Saad

Conference Presentation Abstracts

Introduction Procalcitonin (PCT) is a biomarker that helps distinguish bacterial infections from other causes of infection or inflammation and can be used as a helpful adjunct to clinical judgment to resolve diagnostic uncertainty. However, the reliability of procalcitonin goes down when a patient has Acute kidney injury (AKI). Yet is there any significance for procalcitonin if it is extremely high, in hundreds, same in our patient, despite the patient in AKI and can PCT still be used to help determine mortality along with all other markers, or independent from other markers. Case report 36 years old male with PMH of …

Residency As A Rite Of Passage: Assessing Liminality In Night Float And Improving Competency Evaluations, Lily Anderson-Chavarria, James Meza, Frank Mueller, Jianming Lau

Conference Presentation Abstracts

Purpose/Background: ACGME emphasizes competency-based evaluation of post-graduate education. However, written evaluations using averaged Likert Scales with minimal anchoring to real experiences is a sub-optimal method of evaluating resident competence. Through qualitative research, we explored resident’s own reflections on their transition into competent physicians and attempted to identify an alternative model for resident assessment. Based on informal observations, we predicted that night float rotations in the second-year curriculum are determinative for residents to achieve competence in clinical care. We further hypothesized that residents’ experiences mirror a Rite of Passage marked by rituals of separation, transition and reintegration, with night float serving …

Rethinking Mixed Dka-Hhs: An Extreme Presentation Of Hyperosmolar Hyperglycemic State, Sajith Silva, Umair Malik, Amin Pasha, Sujata Kambhatla

Conference Presentation Abstracts

Introduction: The American Diabetes Association (ADA) recognizes diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) as life-threatening hyperglycemic emergencies that can overlap clinically; approximately 10% of presentations are described as mixed DKA–HHS. Because current guidelines do not define a single “mixed” category, overlap is best understood as concurrent fulfillment of key elements of both syndromes: DKA-type anion-gap metabolic acidosis with ketonemia or ketonuria, together with HHS-type severe hyperglycemia, hyperosmolality, and dehydration. We report an extreme HHS presentation (glucose >2,100 mg/dL) with limited DKA overlap. Case Description: A 34-year-old woman with longstanding type 1 diabetes mellitus managed with an insulin pump, …

A Rare Price Of Pain Control: Methemoglobinemia From A Lidocaine Patch, Sushmita Mantravadi, Kesava Mankikanta Achuta, Aaron Goyal, Amin Pasha, Abed L. Dabaja

Conference Presentation Abstracts

Introduction The overall prevalence of methemoglobinemia is around 0.035%. Methemoglobinemia is a rare but potentially life-threatening complication of local anesthetic use. While all patients are at risk, those with cardiac or pulmonary compromise are more susceptible to developing clinical manifestations. We report a case of acquired methemoglobinemia following topical lidocaine patch application for post-operative pain management in an elderly patient. Case Presentation 84-year-old male with a past medical history of aortic stenosis status post Transcatheter aortic valve replacement, Coronary artery disease, gastrointestinal bleed due to colon polyps, obstructive sleep apnea, chronic kidney disease, trigeminal neuralgia, obesity, essential hypertension, chronic atrial …

Operative Versus Non-Operative Management Of Infant Perianal Abscesses: A Pediatric Surgery Research Collaborative Prospective Quality Improvement Study, Leigh Selesner, Chakshu Soni, Romeo C. Ignacio, Rimla Khan, Robert Wright, Alicia Mcintire, Bethany J. Slater, Nathan M. Novotny, Ryan T. Davis, Artem F. Dadamyan

Conference Presentation Abstracts

Abstract: Purpose Treatment of infant perianal abscesses (IPA) remains controversial, with ongoing debate between operative and non-operative management. Recurrence is common and prospective data to guide care are lacking. We performed the first multi-institutional prospective quality improvement (QI) study comparing non-operative to operative IPA management. Methods The primary endpoint was time to complete abscess resolution. Secondary endpoints included surgical intervention (incision and drainage ± fistulotomy) and abscess recurrence. Institutions were recruited through a national research collaborative. IRB approval was obtained individually. Between 2022 and 2025, we prospectively enrolled patients < 1 year of age with an abscess ≤2 cm from the anal verge. Patients with predisposing conditions (e.g. inflammatory bowel disease) were excluded. Management was determined by the treating provider, with either upfront surgical intervention (control group) or non-operative care per our QI protocol (protocol group, Figure 1). Data were collected on management prior to surgical evaluation, presentation, subsequent treatment and outcomes. Statistical analyses were performed using STATA, with p < 0.05 considered significant. Endpoints were compared between groups by non-parametric methods, with denominators based on available data. Results Fourteen institutions participated across the U.S., with a total of 288 patients (108 control, 180 protocol) enrolled. Median follow-up was 0.99 (interquartile range 0.23-3.93) and 1 (0.16-4.56) months for control and protocol groups. Abscess resolution occurred in 155 patients during follow-up (36/71 (51%) control, 119/134 (89%) protocol, p < 0.01). Median time to abscess resolution was 1.21 (0.33-4) and 1.13 (0.57-3.83) months for control and protocol groups (p=0.64). Recurrences were frequent in both cohorts (34/93 (37%) control, 62/153 (41%) protocol). Surgical intervention was significantly more common in the control group: incision and drainage were performed in 61/107 (57%) versus 19/166 (11%) and exam under anesthesia with fistulotomy in 31/106 (29%) versus 20/166 (12%) (both p< 0.01). Conclusions Time to abscess resolution was similar between patients treated with upfront surgical intervention and non-operative management according to our QI protocol. Significantly more patients underwent surgical intervention in the control group, without an impact on time to resolution. Our data support initial non-operative management of infant perianal abscesses, emphasizing antibiotics at initial presentation, sitz baths and family reassurance. Abbreviations: IPA - infant perianal abscess; QI - quality improvement; IRB - institutional review board