Risk factors associated with unplanned readmission following excisional haemorrhoidectomy

Abstract

Aim Excisional haemorrhoidectomy is the gold standard for management of advanced symptomatic haemorrhoids. Although an effective treatment, it is associated with significant postoperative morbidity with pain, bleeding and a high readmission rate. This study seeks to investigate potential risk factors that may predict unplanned 30-day readmissions following excisional haemorrhoidectomy.Method A retrospective cohort review of all haemorrhoidectomies performed at Counties Manukau District Health Board, Auckland, New Zealand, between January 2012 and December 2017 was performed. Baseline demographic data, readmission data and potential variables for readmission were recorded. Univariate and multivariate logistic regression analyses were performed to determine significant variables for readmission within 30 days. ResultsIn total, 485 cases of excisional haemorrhoidectomy were included in the final analysis with 62 (12.8%) unplanned readmissions. The demographics between the no readmission and unplanned readmission groups were similar. Multivariate logistic regression analysis demonstrated that male gender (P = 0.018) and the use of non-diathermy devices (P = 0.017) were significant risk factors for readmission. Initial dispensing of opioid analgesia did not decrease the risk of readmission.Conclusion This study suggests that male gender and surgical technique are associated with increased risk of readmission.What does this paper add to the literature? Haemorrhoids are a common anorectal disease, with symptomatic and advanced cases requiring excisional haemorrhoidectomy for definitive treatment. Although effective, the operation is associated with significant pain and bleeding which results in hospital readmission. This study suggests that male gender and use of non-diathermy devices are associated with increased readmission.

Radiofrequency Ablation for Internal Hemorrhoids: A Case Series

“…Regarding recurrence, open surgery is considered the gold standard with a recurrence rate as low as 1%, whereas stapler hemorrhoidectomy has a higher recurrence rate of 7% [ 10 ]. However, open hemorrhoidectomy is associated with a higher risk of immediate and early postoperative complications including bleeding, surgical site infection, and readmission within 30 days postoperatively [ 11 ].…”