Practice patterns in percutaneous image-guided intraabdominal abscess drainage: Survey of academic and private practice centers

PURPOSE: To evaluate current practice patterns of percutaneous image-guided abdominal and pelvic abscess drainage in academic and private practice centers. MATERIALS AND METHODS: The institutional review board did not require approval for this study. In a survey conducted between November 2002 and February 2003, 493 questionnaires were sent to 193 academic and 300 private practice radiology departments in the United States. All recipients were informed of the study purpose. The survey included questions about departmental demographics, patient selection criteria for percutaneous abscess drainage (eg, abscess diameter at imaging, laboratory parameters such as white blood cell count, and clinical indications such as fever), use of analgesia or conscious sedation, drainage method, and imaging technique. The statistical significance of differences between respondent subgroups was analyzed with a Pearson or Mantel-Haenszel chi(2) test. RESULTS: Academic centers returned 95 questionnaires (49%), and private practice centers, 72 (24%). Percutaneous abscess drainage is performed by a fellowship-trained radiologist at 92 (97%) of 95 academic centers and 41 (79%) of 52 private practice centers ( P <.001). Among 95 academic respondents and 52 private practice respondents, respectively, 56 (59%) and 33 (63%) do not perform drainage if an abscess has a diameter of less than 3 cm; 30 (32%) and nine (17%), if the white blood cell count is normal; and 16 ( 17%) and six (12%), if the patient is afebrile. Most ( 90 [95%] of 95 academic, 45 [87%] of 52 private practice) respondents use conscious sedation. A transabdominal approach and 8-12-F catheters are most frequently used by both groups. Academic respondents more frequently use transvaginal and transrectal approaches ( 54 [57%] and 51 [54%] of 95, vs 16 [31%] and 15 [29%] of 52 private practice respondents; P =.003) and 14-F catheters ( 69 [73%] of 95 vs 18 [35%] of 52; P <.001). CONCLUSION: Percutaneous drainage is usually performed by fellowship-trained radiologists in abscesses of more than 3 cm in diameter, for appropriate clinical indications ( multiple parameters above the established threshold), by using conscious sedation and 8-12-F catheters.