Outcome of a care protocol in a dedicated pilonidal care clinic
Madelyn McArthur, Kathleen Renzi, Gheed Murtadi, Nikki Check, David P. Mooney*
Surgery, Boston Children's Hospital, Boston, MA
1. Objective: To describe the outcome of a dedicated pilonidal care clinic"™s minimally invasive protocol.
2. Design: Prospectively collected patient demographic information, disease severity, treatment provided and outcome were compared based upon the time interval of the patient"™s first visit: before clinic protocol was finalized: January 1, 2019, and after implementation: January 1, 2020.
3. Setting: An outpatient pediatric surgical specialty clinic, staffed by personnel from an academic pediatric medical center.
4. Patients: Consecutive patients with pilonidal disease cared for in the clinic from its inception in 2013 to January 1, 2023, excluding the protocol implementation transition year: 2019.
5. Interventions: Clinic interventions include an intake demographic, disease symptoms, disease condition and prior treatments survey. Patients then complete a return visit survey for each subsequent visit. Clinicians complete a disease severity and treatment survey following each visit. Clinic care protocol consists of: twice daily cleansing of the gluteal crease to minimize debris available to enter crease skin pits, closure of any 3 mm or less crease skin pits, and laser ablation of crease follicles to prevent future skin pit formation. Treatments proceed until the skin pits are closed and the crease follicles are no longer productive.
6. Main Outcome Measure: Final disease condition.
7. Results: From 2013 to 2023, 1,100 patients were managed, 99.4% without an operation. At intake, 601 (53%) had mild disease, 343 (30%) had moderate disease, 86 (7.6%) had severe disease, and 79 (7.0%) had a dehisced wound. The average onset of disease for 651 male patients (59%) was 16.1 years and for 449 females (41%) 14.9 years. Prior to 2019, 335 patients were seen and none received an intervention on their initial visit (See Table). After implementation of the clinic protocol, treatments were offered at the first visit, more patients were disease free and fewer were lost to follow up.
8. Conclusions: A dedicated pilonidal care clinic directed toward minimally invasive care resulted in a less than 1% operative rate for this condition. Once clinic protocols were fully enacted, the disease resolution rate increased while the lost to follow up rate decreased.
Table: Outcomes before and after protocol implementation (percentages)
| Lost to Follow up | |||||||||
| Number | Initial Laser | Initial Pit | Grad | Care | Total | Split | Active | Hirsute | |
| Before Protocol | 335 | 0 | 0 | 21 | 0 | 67 | 11 | 55 | 12 |
| Protocol | 651 | 78 | 54 | 29 | 25 | 30 | 15 | 16 | 14 |
Legend: N=Number, Pit=pit picking, Grad=disease free graduation, Care=ongoing care, Split=lost to follow up after pit picking, Active=active disease when last seen, Hirsute=no active disease but hirsute. Data presented as percentages.
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