Afua Agyei
Introduction
Acute subcutaneous abscesses are a common surgical presentation, managed with incision and drainage (I&D). Existing pressure on emergency theatre lists results in longer waiting times, glycaemic abnormalities due to prolonged fasting, bed shortages and patient dissatisfaction. Many cases are suitable for I&D under
local anaesthesia (L/A), which can improve efficiency through a dedicated ambulatory pathway
Methods
A baseline audit of 158 patients with subcutaneous abscesses from January to March 2025 identified low L/A use for I&D, unnecessary admissions and long wait times. An abscess leaflet and abscess pathway with emphasis on L/A for nonseptic patients with subcutaneous abscesses in all locations except breast, pilonidal, perianal and intraabdominal were introduced. Post-intervention data was collected on 139 patients from September to December 2025 and compared to the baseline.
Results
Following implementation, 42.16% of eligible abscesses were drained under L/A, representing a 59% increase from a baseline of 26.38%. Median time spent in hospital for patients who had L/A was 4.5 hours compared to 26 hours in patients who had general anaesthesia with improved patient satisfaction. The recurrence
rate of 8.3% was comparable to standard rates, with no allergic reaction to L/A. The service reduced reliance on emergency theatre capacity and avoided unnecessary admissions.
Conclusion
A dedicated local abscess service is a safe and effective model that improves patient flow and access to care. Increased use of L/A significantly reduces waiting times and hospital resource utilisation, while maintaining acceptable clinical outcomes.
Authors
Afua Agyei, Sadaf Khalid, Gaurav Maheshwari
Medway Maritime Hospital, Kent, United Kingdom