Refining postoperative quality metrics: risk factors for emergency department visits within 3 days after hemorrhoidectomy.

Abstract

Background: Very early hospital revisits following hemorrhoidectomy, particularly within 3 days of discharge, may reflect preventable peri-discharge complications more accurately than traditional 30-day readmission rates. However, few studies have systematically examined risk factors associated with this short-term outcome under real-world conditions.

Methods: We conducted a retrospective cohort study of 662 patients who underwent conventional hemorrhoidectomy for grade III or IV hemorrhoids at Lotung Poh-Ai Hospital between 2021 and 2023. The primary outcome was return to the emergency department (ED) within 3 days of discharge. Clinical, operative, and postoperative variables were analyzed using multivariate logistic regression.

Results: Of 662 patients, 46 (6.95%) returned to the ED within 3 days. The most common presenting symptom was severe wound pain (78.3%). Multivariate analysis identified thrombosed hemorrhoids (adjusted odds ratio [aOR], 3.05; 95% CI, 1.56-5.96; p = 0.001) and use of ≥ 2 postoperative analgesics (aOR, 3.96; 95% CI, 1.99-7.84; p < 0.001) as independent predictors of early ED revisit. Other clinical and laboratory variables were not significantly associated.

Conclusions: This study is among the first to identify specific predictors of ED visits within 3 days after hemorrhoidectomy. The presence of thrombosed hemorrhoids and escalated analgesic use may signal patients at risk for very early unplanned revisits. These findings challenge reliance on 30-day readmission metrics and support 72-h revisit rates as a sensitive quality indicator for discharge appropriateness and perioperative care.