Abscess Outcomes in a Rural Setting: A Retrospective Observational Study at Mount Gambier and Districts Health Service ( MGDHS )

BACKGROUND: Abscesses are resource intensive presentations in Australian Emergency Departments (EDs). At Mount Gambier and Districts Health Service (MGDHS), the absence of onsite subspecialty services necessitates interhospital transfer to tertiary centres for anatomically high-risk infections. This study identifies drivers of retrieval to inform regional service optimisation while maintaining surgical safety standards. METHODS: A retrospective cohort study was conducted on all abscess presentations to MGDHS over a 2-year period (2023-2024). Demographic, clinical and laboratory data were analysed to identify predictors of tertiary retrieval. RESULTS: Of the total cohort (N = 455), tertiary retrieval (n = 23) was overwhelmingly driven by anatomical location rather than physiological instability, with head and neck presentations accounting for 91% of transfers. Retrieved patients demonstrated a significant, three-fold increase in median C-Reactive Protein (156.7 vs. 50.64 mg/L, p ≤ 0.001). While 83% required subspecialty tertiary input, 57% of retrieved patients were managed with bedside incision and drainage (I&D) within the tertiary environment rather than the operating theatre. Regional management remained effective, with a 5% failure rate of conservative management and an 8.6% 30-day re-presentation rate. Estimated retrieval expenditure totalled $230 000, with $130 000 attributed to cases requiring only ward-based intervention. CONCLUSION: Tertiary retrieval at MGDHS is predominantly driven by anatomical location and airway compromise risk rather than procedural complexity. Implementing telehealth triage, hub-and-spoke networks and multidisciplinary airway support can safely mitigate avoidable transfers. Supporting subspecialty services and these targeted approaches decreases costs, reduces tertiary strain and enhances equitable rural surgical care without compromising patient safety.