BackgroundPerianal abscess is a common disease among adults, necessitating surgical drainage. We aimed to assess the role of microbiology and other factors in prolonged hospitalization of patients with perianal abscesses. MethodsThis retrospective study included all patients aged 18 or older who underwent surgical incision and drainage for perianal abscess in a single medical center between 2016 and 2020. Data regarding demographics, bacteriological cultures, and length of hospital stay were collected via electronic patient charts. A prolonged hospital stay was defined as a LOS longer than 3 days. ResultsA total of 791 patients were included, of which 77.5% were male, with a mean age of 43.2. Overall, 46.1% of patients had positive cultures, of which 69.9% were polymicrobial. The most common pathogen found in obtained cultures was Escherichia coli (69.9%), followed by streptococcus species (36.7%) and Bacteroides (26.0%). Females had a significantly longer hospital stay (p = 0.03). Prolonged hospital stay was associated with older age (p < 0.0001), female gender (p = 0.04), and positive cultures for Enterococcus (p = 0.02). ConclusionsThis study identified clinical and microbiological risk factors for prolonged hospitalization in patients with perianal abscesses. Further studies are needed to evaluate the association between specific pathogens and rates of complications.