{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T18:55:40Z","timestamp":1790103340036,"version":"4.0.1"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"13","license":[{"start":{"date-parts":[[2017,8,31]],"date-time":"2017-08-31T00:00:00Z","timestamp":1504137600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,11,16]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Progression from anorectal abscess to fistula is poorly described and it remains unclear which patients develop a fistula following an abscess. The aim was to assess the burden of anorectal abscess and to identify risk factors for subsequent fistula formation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The Hospital Episode Statistics database was used to identify all patients presenting with new anorectal abscesses. Cox regression analysis was undertaken to identify factors predictive of fistula formation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 165 536 patients were identified in the database as having attended a hospital in England with an abscess for the first time between 1997 and 2012. Of these, 158 713 (95\u00b79 per cent) had complete data for all variables and were included in this study, the remaining 6823 (4\u00b71 per cent) with incomplete data were excluded from the study. The overall incidence rate of abscess was 20\u00b72 per 100 000. The rate of subsequent fistula formation following an abscess was 15\u00b75 per cent (23 012 of 148 286) in idiopathic cases and 41\u00b76 per cent (4337 of 10 427 in patients with inflammatory bowel disease (IBD) (26\u00b77 per cent coded concurrently as ulcerative colitis; 47\u00b72 per cent coded as Crohn's disease). Of all patients who developed a fistula, 67\u00b75 per cent did so within the first year. Independent predictors of fistula formation were: IBD, in particular Crohn's disease (hazard ratio (HR) 3\u00b751; P &amp;lt; 0\u00b7001), ulcerative colitis (HR 1\u00b782; P &amp;lt; 0\u00b7001), female sex (HR 1\u00b718; P &amp;lt; 0\u00b7001), age at time of first abscess 41\u201360 years (HR 1\u00b785 versus less than 20 years; P &amp;lt; 0\u00b7001), and intersphincteric (HR 1\u00b753; P &amp;lt; 0\u00b7001) or ischiorectal (HR 1\u00b748; P &amp;lt; 0\u00b7001) abscess location compared with perianal. Some 2\u00b79 per cent of all patients presenting with a new abscess were subsequently diagnosed with Crohn's disease; the median time to diagnosis was 14 months.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>The burden of anorectal sepsis is high, with subsequent fistula formation nearly three times more common in Crohn's disease than idiopathic disease, and female sex is an independent predictor of fistula formation following abscess drainage. Most fistulas form within the first year of presentation with an abscess.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.10614","type":"journal-article","created":{"date-parts":[[2017,8,31]],"date-time":"2017-08-31T12:18:36Z","timestamp":1504181916000},"page":"1857-1865","source":"Crossref","is-referenced-by-count":69,"title":["Natural history of anorectal sepsis"],"prefix":"10.1093","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3885-5752","authenticated-orcid":false,"given":"K","family":"Sahnan","sequence":"first","affiliation":[{"name":"Surgical Epidemiology, Trials and Outcome Centre, St Mark's Hospital and Academic Institute, Harrow, UK"},{"name":"Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK"},{"name":"Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Askari","sequence":"additional","affiliation":[{"name":"Surgical Epidemiology, Trials and Outcome Centre, St Mark's Hospital and Academic Institute, Harrow, UK"},{"name":"Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S O","family":"Adegbola","sequence":"additional","affiliation":[{"name":"Surgical Epidemiology, Trials and Outcome Centre, St Mark's Hospital and Academic Institute, Harrow, UK"},{"name":"Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK"},{"name":"Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P J","family":"Tozer","sequence":"additional","affiliation":[{"name":"Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK"},{"name":"Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R K S","family":"Phillips","sequence":"additional","affiliation":[{"name":"Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK"},{"name":"Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A","family":"Hart","sequence":"additional","affiliation":[{"name":"Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK"},{"name":"Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O D","family":"Faiz","sequence":"additional","affiliation":[{"name":"Surgical Epidemiology, Trials and Outcome Centre, St Mark's Hospital and Academic Institute, Harrow, UK"},{"name":"Fistula Research Unit, St Mark's Hospital and Academic Institute, Harrow, UK"},{"name":"Department of Surgery and Cancer, Imperial College, St Mary's Hospital, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2017,8,31]]},"reference":[{"key":"2021020617164952300_bjs10614-bib-0001","doi-asserted-by":"crossref","first-page":"1063","DOI":"10.1002\/bjs.10154","article-title":"North West Research Collaborative. Multicentre observational study of outcomes after drainage of acute perianal abscess","volume":"103","author":"Pearce","year":"2016","journal-title":"Br J Surg"},{"key":"2021020617164952300_bjs10614-bib-0002","first-page":"219","article-title":"Fistula-in-ano in a defined population. Incidence and epidemiological aspects","volume":"73","author":"Sainio","year":"1984","journal-title":"Ann Chir Gynaecol"},{"key":"2021020617164952300_bjs10614-bib-0003","doi-asserted-by":"crossref","first-page":"1459","DOI":"10.1007\/s00384-007-0334-7","article-title":"An assessment of the incidence of fistula-in-ano in four countries of the European Union","volume":"22","author":"Zanotti","year":"2007","journal-title":"Int J Colorectal Dis"},{"key":"2021020617164952300_bjs10614-bib-0004","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s00384-002-0429-0","article-title":"Randomized clinical trial comparing simple drainage of anorectal abscess with and without fistula track treatment","volume":"18","author":"Oliver","year":"2003","journal-title":"Int J Colorectal Dis"},{"key":"2021020617164952300_bjs10614-bib-0005","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1007\/BF02587008","article-title":"A prospective survey of 474 patients with anorectal abscess","volume":"22","author":"Read","year":"1979","journal-title":"Dis Colon Rectum"},{"key":"2021020617164952300_bjs10614-bib-0006","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1007\/BF02553995","article-title":"The incidence of recurrent abscesses or fistula-in-ano following anorectal suppuration","volume":"27","author":"Vasilevsky","year":"1984","journal-title":"Dis Colon Rectum"},{"key":"2021020617164952300_bjs10614-bib-0007","first-page":"243","article-title":"Anal fistula in India","volume":"61","author":"Raghavaiah","year":"1976","journal-title":"Int Surg"},{"key":"2021020617164952300_bjs10614-bib-0008","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/S0095-4543(05)70102-0","article-title":"Anorectal abscess and fistula","volume":"26","author":"Hyman","year":"1999","journal-title":"Prim Care"},{"key":"2021020617164952300_bjs10614-bib-0009","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1016\/S0196-0644(95)70170-2","article-title":"Perirectal abscess","volume":"25","author":"Marcus","year":"1995","journal-title":"Ann Emerg Med"},{"key":"2021020617164952300_bjs10614-bib-0010","first-page":"266","volume":"36","author":"Turra","year":"1984","journal-title":"Chir Ital"},{"key":"2021020617164952300_bjs10614-bib-0011","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/BF00703954","article-title":"One stage treatment of anal abscesses and fistulas. A clinical appraisal on the basis of two different classifications","volume":"6","author":"Fucini","year":"1991","journal-title":"Int J Colorectal Dis"},{"key":"2021020617164952300_bjs10614-bib-0012","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1007\/BF02070708","article-title":"Randomized controlled trial of primary fistulotomy with drainage alone for perianal abscesses","volume":"40","author":"Ho","year":"1997","journal-title":"Dis Colon Rectum"},{"key":"2021020617164952300_bjs10614-bib-0013","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1007\/BF02054531","article-title":"Prospective randomized trial of drainage alone vs. drainage and fistulotomy for acute perianal abscesses with proven internal opening","volume":"39","author":"Tang","year":"1996","journal-title":"Dis Colon Rectum"},{"key":"2021020617164952300_bjs10614-bib-0014","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1007\/BF02050209","article-title":"Treatment of anorectal abscess with or without primary fistulectomy. Results of a prospective randomized trial","volume":"34","author":"Schouten","year":"1991","journal-title":"Dis Colon Rectum"},{"key":"2021020617164952300_bjs10614-bib-0015","doi-asserted-by":"crossref","first-page":"j475","DOI":"10.1136\/bmj.j475","article-title":"Perianal abscess","volume":"356","author":"Sahnan","year":"2017","journal-title":"BMJ"},{"key":"2021020617164952300_bjs10614-bib-0016","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1016\/j.jviscsurg.2014.07.008","article-title":"Treatment of anal fistula and abscess","volume":"152","author":"Pigot","year":"2015","journal-title":"J Visc Surg"},{"key":"2021020617164952300_bjs10614-bib-0017","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1136\/gut.21.6.525","article-title":"Occurrence and outcome after primary treatment of anal fistulae in Crohn's disease","volume":"21","author":"Hellers","year":"1980","journal-title":"Gut"},{"key":"2021020617164952300_bjs10614-bib-0018","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1053\/gast.2002.32362","article-title":"The natural history of fistulizing Crohn's disease in Olmsted County, Minnesota","volume":"122","author":"Schwartz","year":"2002","journal-title":"Gastroenterology"},{"key":"2021020617164952300_bjs10614-bib-0019","doi-asserted-by":"crossref","first-page":"3504","DOI":"10.3748\/wjg.15.3504","article-title":"Perianal disease, small bowel disease, smoking, prior steroid or early azathioprine\/biological therapy are predictors of disease behavior change in patients with Crohn's disease","volume":"15","author":"Lakatos","year":"2009","journal-title":"World J Gastroenterol"},{"key":"2021020617164952300_bjs10614-bib-0020","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.3748\/wjg.v21.i5.1394","article-title":"Management of perianal fistulas in Crohn's disease: an up-to-date review","volume":"21","author":"Marzo","year":"2015","journal-title":"World J Gastroenterol"},{"key":"2021020617164952300_bjs10614-bib-0021","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1067\/msy.2000.108779","article-title":"Surgical treatment of anorectal complications in Crohn's disease","volume":"128","author":"Michelassi","year":"2000","journal-title":"Surgery"},{"key":"2021020617164952300_bjs10614-bib-0022","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1007\/BF02068077","article-title":"Long-term seton drainage for high anal fistulas in Crohn's disease \u2013 a sphincter-saving operation?","volume":"39","author":"Faucheron","year":"1996","journal-title":"Dis Colon Rectum"},{"key":"2021020617164952300_bjs10614-bib-0023","doi-asserted-by":"crossref","first-page":"529","DOI":"10.1007\/BF02058706","article-title":"Perianal Crohn's disease. Results of local surgical treatment","volume":"39","author":"Sangwan","year":"1996","journal-title":"Dis Colon Rectum"},{"key":"2021020617164952300_bjs10614-bib-0024","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1007\/BF02053687","article-title":"Fistula-in-ano in Crohn's disease. Results of aggressive surgical treatment","volume":"34","author":"Williams","year":"1991","journal-title":"Dis Colon Rectum"},{"key":"2021020617164952300_bjs10614-bib-0025","first-page":"36","article-title":"The comparative anatomy and pathology of anal glands. Arris and Gale lecture delivered at the Royal College of Surgeons of England on 25th February 1965","volume":"40","author":"McColl","year":"1967","journal-title":"Ann R Coll Surg Engl"},{"key":"2021020617164952300_bjs10614-bib-0026","author":"Office for National Statistics","year":"2011","journal-title":"2011 UK Censuses"},{"key":"2021020617164952300_bjs10614-bib-0027","doi-asserted-by":"crossref","first-page":"338","DOI":"10.1016\/j.crohns.2011.02.011","article-title":"Perianal disease in patients with ulcerative colitis: a case\u2013control study","volume":"5","author":"Zabana","year":"2011","journal-title":"J Crohns Colitis"},{"key":"2021020617164952300_bjs10614-bib-0028","doi-asserted-by":"crossref","first-page":"1357","DOI":"10.1007\/BF02237048","article-title":"Incidence of fistulas after drainage of acute anorectal abscesses","volume":"41","author":"H\u00e4m\u00e4l\u00e4inen","year":"1998","journal-title":"Dis Colon Rectum"},{"key":"2021020617164952300_bjs10614-bib-0029","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1097\/DCR.0b013e31821cc1f9","article-title":"Does adjuvant antibiotic treatment after drainage of anorectal abscess prevent development of anal fistulas? A randomized, placebo-controlled, double-blind, multicenter study","volume":"54","author":"S\u00f6zener","year":"2011","journal-title":"Dis Colon Rectum"},{"key":"2021020617164952300_bjs10614-bib-0030","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1007\/DCR.0b013e31819a5c52","article-title":"Who is at risk for developing chronic anal fistula or recurrent anal sepsis after initial perianal abscess?","volume":"52","author":"Hamadani","year":"2009","journal-title":"Dis Colon Rectum"},{"key":"2021020617164952300_bjs10614-bib-0031","doi-asserted-by":"crossref","first-page":"1495","DOI":"10.1007\/s00384-010-1011-9","article-title":"Prognostic factors for recurrence following the initial drainage of an anorectal abscess","volume":"25","author":"Yano","year":"2010","journal-title":"Int J Colorectal Dis"},{"key":"2021020617164952300_bjs10614-bib-0032","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/MCG.0000000000000169","article-title":"Effectiveness of adalimumab in perianal fistulas in Crohn's disease patients naive to anti-TNF therapy","volume":"49","author":"Casta\u00f1o-Milla","year":"2015","journal-title":"J Clin Gastroenterol"},{"key":"2021020617164952300_bjs10614-bib-0033","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1097\/DCR.0b013e31825228b0","article-title":"The spectrum of perianal Crohn's disease in a population-based cohort","volume":"55","author":"Eglinton","year":"2012","journal-title":"Dis Colon Rectum"},{"key":"2021020617164952300_bjs10614-bib-0034","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1002\/ibd.21719","article-title":"Swiss IBD Cohort Study Group. Systematic evaluation of risk factors for diagnostic delay in inflammatory bowel disease","volume":"18","author":"Vavricka","year":"2012","journal-title":"Inflamm Bowel Dis"},{"key":"2021020617164952300_bjs10614-bib-0035","doi-asserted-by":"crossref","first-page":"1744","DOI":"10.1038\/ajg.2013.248","article-title":"IBD Cohort Study Group. Diagnostic delay in Crohn's disease is associated with a complicated disease course and increased operation rate","volume":"108","author":"Schoepfer","year":"2013","journal-title":"Am J Gastroenterol"},{"key":"2021020617164952300_bjs10614-bib-0036","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/S0140-6736(08)60304-9","article-title":"North-Holland Gut Club. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn's disease: an open randomised trial","volume":"371","author":"D'Haens","year":"2008","journal-title":"Lancet"},{"key":"2021020617164952300_bjs10614-bib-0037","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1093\/pubmed\/fdr054","article-title":"Systematic review of discharge coding accuracy","volume":"34","author":"Burns","year":"2012","journal-title":"J Public Health (Bangkok)"}],"container-title":["British Journal of Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbjs.10614","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/104\/13\/1857\/36206840\/bjs10614.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/bjs\/article-pdf\/104\/13\/1857\/36206840\/bjs10614.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,5,20]],"date-time":"2021-05-20T14:18:29Z","timestamp":1621520309000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/104\/13\/1857-1865\/6122936"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8,31]]},"references-count":37,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2017,8,31]]},"published-print":{"date-parts":[[2017,11,16]]}},"URL":"https:\/\/doi.org\/10.1002\/bjs.10614","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"value":"0007-1323","type":"print"},{"value":"1365-2168","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2017,12]]},"published":{"date-parts":[[2017,8,31]]}}}