EP691 - Post-Hemorrhoidectomy Emergency Department Utilization: A Retrospective Review of a Tertiary Care Center

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Purpose/Background: Excisional hemorrhoidectomy (EH) is a common procedure to treat medically refractory grade III and IV hemorrhoids. Despite being a same-day surgery, EH is marked by a notoriously difficult recovery. Expectation management, adequate post-operative instructions and sufficient use of multimodality pain regimens may play a critical role in a successful at-home recovery. However, complications, difficulty understanding post-operative instructions, logistical barriers to medications from pharmacies/insurance companies, or decreased access to outpatient medical advice may contribute to patients’ need to seek emergency treatment during recovery. The aim of this study was to characterize emergency care utilization following EH, and to determine potentially modifiable factors associated with utilization.

Methods/Interventions: A retrospective cohort study of adult patients who underwent excisional hemorrhoidectomy within a multi-hospital health system between 2018 and 2024 was performed. The electronic health record was reviewed for patient demographics, operative details, and emergency department (ED) utilization within 30 days of operation. Descriptive statistics were performed. Univariate analyses were done to determine if differences existed between patients with and without ED utilization.

Results/Outcomes: A total of 127 patients were identified who underwent EH with one of 8 surgeons. Of those, 24 (18.9%) presented to the ED at a mean of 5 days post-op(IQR3,11). Six patients (25%) presented multiple times. The most common presenting complaint was pain (11;45.8%), with a median pain score of 8.5(IQR7,10). This is compared to a median pain rating of 6(IQR 0,9) for those who presented with a non-pain related chief complaint. There was no significant difference in the mean number of narcotic pain medications prescribed at discharge from surgery between groups (21.5 tabs for ED patients vs.19.8, p=0.51). The second most common reason for presentation was urinary retention (5, 38.5%), and bleeding accounted for 12.5% (3). Only 13(54.2%) had surgical consultation from the ED, 8(33.3%) were admitted to the hospital, and 1 patient underwent reoperation. A CT was performed in 50% of patients. There were no significant differences between groups in terms of smoking status, insurance status, antiplatelet or anticoagulant use, number of columns excised or use of a bipolar energy device.

Conclusion/Discussion: Nearly 1 in 5 patients utilized the ED as a resource for evaluation and management of postoperative pain following EH, yet only half of the time was the surgical team consulted. Admission to the hospital from the ED is rare, and reoperation is even less frequent. This system-wide study investigating ED utilization serves as a quality benchmark for ours and other health systems and may inspire new mitigation strategies to decrease unnecessary utilization.