Risk Factors for Readmission in Excisional Hemorrhoidectomy at a Tertiary Teaching Center.
| Title: | Risk Factors for Readmission in Excisional Hemorrhoidectomy at a Tertiary Teaching Center. |
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| Authors: | Siggins LA; Department of Surgery, Te Whatu Ora - Capital, Coast and Hutt Valley, Wellington, New Zealand.; Fagan PVB; Department of Surgery, Te Whatu Ora - Capital, Coast and Hutt Valley, Wellington, New Zealand.; Kim HM; Dean's Department, University of Otago, Wellington, New Zealand.; Lin AY; Department of Surgery, Te Whatu Ora - Capital, Coast and Hutt Valley, Wellington, New Zealand; Department of Surgery and Anesthesia, University of Otago, Wellington, New Zealand. Electronic address: tony.lin@otago.ac.nz. |
| Source: | The Journal of surgical research [J Surg Res] 2024 May; Vol. 297, pp. 128-135. Date of Electronic Publication: 2024 Mar 18. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Academic Press Country of Publication: United States NLM ID: 0376340 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1095-8673 (Electronic) Linking ISSN: 00224804 NLM ISO Abbreviation: J Surg Res Subsets: MEDLINE |
| Imprint Name(s): | Publication: New York, NY : Academic Press; Original Publication: Philadelphia [etc.] |
| MeSH Terms: | Hemorrhoidectomy*/adverse effects; Postoperative Complications/etiology ; Humans ; Patient Readmission ; Retrospective Studies ; Risk Factors ; Pain |
| Abstract: | Introduction: Unplanned readmission is often seen after excisional hemorrhoidectomy. This study aims to explore associations between patient and operative factors, and readmission rates in excisional hemorrhoidectomy.; Methods: We performed a retrospective analysis of all excisional hemorrhoidectomies performed in Capital and Coast District Health Board for an 8-year period from January 1, 2012, to December 31, 2020. The primary outcome measure was 30-day readmissions post hemorrhoidectomy. Univariate and multivariable logistic regression analyses were performed to identify risk factors to readmisson. A decision tree model was designed to further look at the interactions between risk factors.; Results: There were a total 370 patients undergoing 389 excisional hemorrhoidectomies over the study period. There were 47 (12.1%) readmissions. The commonest reasons for readmission were pain (48.9%) and bleeding (38%). 17% of readmitted patients required operative intervention. Readmission was associated with the use of advanced energy devices (OR 2.21; P = 0.027). Trainees were more likely to use advance energy devices than consultants (51% versus 38%, P = 0.010). Consultants were involved in more procedures requiring a removal of 3 pedicles or more than trainees (43% versus 30%, P = 0.010). A decision tree model predicts readmission based on primary operator experience, age, advanced energy device use, and patient ethnicity.; Conclusions: Two risk models are presented showing the complex relationship between the factors associated with readmission after hemorrhoidectomy. Advanced energy device use was associated with an increased risk of readmission after hemorrhoidectomy in our population. Future work could involve targeted interventions to patients at increased risk of readmission such as preprocedural and postprocedural information, early interval follow-up and targeted analgesia regimes.; (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.) |
| Contributed Indexing: | Keywords: Colorectal surgery; Hemorrhoidectomy; Patient readmission |
| Entry Date(s): | Date Created: 20240319 Date Completed: 20240419 Latest Revision: 20260412 |
| Update Code: | 20260413 |
| DOI: | 10.1016/j.jss.2024.02.013 |
| PMID: | 38503194 |
| Database: | MEDLINE |
Journal Article