Abstract
BACKGROUND: Anorectal abscesses are common surgical conditions associated with a high risk of recurrence or fistula formation. Although several studies have investigated the potential predictors, data from Saudi Arabia remain limited. This study aimed to assess the rate, timing, and predictors of recurrence or fistula formation following the primary surgical drainage of anorectal abscesses. METHODS: We conducted a five-year retrospective cohort study at King Fahad Hospital of the University in Al Khobar, Saudi Arabia, including all patients who underwent surgical incision and drainage for a first-time anorectal abscess between January 2019 and December 2023. Demographic data, abscess characteristics, operative details, and follow-up outcomes were analyzed. Logistic regression and Cox proportional hazards models were used to identify the predictive factors. RESULTS: Among 302 patients, 51.7% (n = 156) developed either a recurrent abscess (12.9%, n = 39) or an index perianal fistula (38.7%, n = 117) during follow-up. The mean time to recurrence was 19.5 weeks. Complex abscesses, observed in 28.1% (n = 85) of cases, were the only independent predictor of earlier recurrence (hazard ratios [HR]: 2.391, p < 0.001). Preoperative imaging was also associated with an increased risk in logistic regression analysis. Seton placement was rare (2.6%, n = 8), despite intraoperative fistula detection in 17.9% (n = 54) of cases. CONCLUSION: Recurrence and fistula formation following drainage of first-time anorectal abscesses are common and tend to occur early. Abscess complexity is a key predictor of poor outcomes, highlighting the need for structured early follow-up and risk-based surgical planning.