EP693 - Who’s Looking? Evaluation of Pre-Referral Physical Exams in Patients Presenting with Anorectal Complaints

Monday, May 12, 2025

10:58 AM – 11:03 AM PT

ePoster Presenter(s)

FH

Frances Hu, MD, MSc

Colorectal Surgery Fellow
UMass Memorial
Worcester, Massachusetts, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.

Author(s)

Benjamin Gallant, MD

Resident
UMass Chan Medical School
Leicester, MA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
Andrew Hu, MD

Mark Kusek Colorectal Research Fellow
UMass Chan Medical School
Worcester, MA, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
MM

Marcus McKenzie, n/a

Medical Student
UMass Chan Medical School
Worcester, Massachusetts, United States

Disclosure information not submitted.
KN

Kathy H. Nguyen, n/a

Medical Student
UMass Chan Medical School
Worcester, Massachusetts, United States

Disclosure information not submitted.
HH

HyukJoo Hwang, n/a

Medical Student
University of Massachusetts Chan Medical School
Shrewsbury, Massachusetts, United States

Disclosure information not submitted.
TP

Thomas Peponis, MD

Colon and Rectal Surgeon, Assistant Professor of Surgery
University of Massachusetts
Worcester, Massachusetts, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no financial relationships with ineligible companies.
PS

Paul R. Sturrock, MD

Assistant Professor of Surgery
UMass Memorial Medical Center
Worcester, Massachusetts, United States

Disclosure information not submitted.
Justin A. Maykel, MD (he/him/his)

Chief, Division of Colorectal Surgery
UMass Memorial Medical Center
UMass Chan Medical
Worcester, Massachusetts, United States

All of the relevant financial relationships listed below have been mitigated.
This individual has no relevant relationships with ineligible companies.
Karim Alavi, MD, MPH

Colon and Rectal Surgeon
UMass Chan Medical School
Worcester, Massachusetts, United States

Disclosure information not submitted.

Senior Author(s)

TA

Tess H. Aulet, MD

Colorectal Surgeon
UMass Memorial
Worcester, Massachusetts, United States

Disclosure information not submitted.

All of the relevant financial relationships listed below have been mitigated.

Frances Hu, MD, MSc: This individual has no financial relationships with ineligible companies.

Benjamin Gallant, MD: This individual has no financial relationships with ineligible companies.

Andrew Hu, MD: This individual has no financial relationships with ineligible companies.

Thomas Peponis, MD: This individual has no financial relationships with ineligible companies.

Justin A. Maykel, MD: This individual has no relevant relationships with ineligible companies.

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Purpose/Background: Anorectal complaints comprise a significant proportion of clinic visits in colorectal surgery. Referrals are frequently made by clinicians from other specialties and labeled generically as ‘hemorrhoids’ or with a single symptom, such as bleeding or pain. Little is known about the scope of patient evaluation for these complaints prior to referral to a specialist. We aimed to assess the extent of physical examination occurring in patients with anorectal complaints prior to referral to a colorectal surgery clinic.

Methods/Interventions: We conducted a retrospective cohort study from January 2022 to July 2024 of patients referred with an anorectal complaint (e.g. hemorrhoid, anal fissure, anal mass, anal fistula) to a colorectal surgery clinic at a tertiary academic medical center. We performed a chart review of a random sample of patient referrals and excluded patients who had referrals but not yet presented to clinic as well as those who had missing information regarding their referral. We collected patient variables, including demographics and past medical history, as well as clinic visit variables, including reason for referral and prior history of anorectal disease. The primary outcome measure was documentation of an anorectal exam prior to patient referral to colorectal surgery clinic. Secondary outcomes included components of anorectal examination when performed and concordance of anorectal diagnosis between referring clinician and colorectal surgeon.

Results/Outcomes: Of 300 patients referred with anorectal complaints, we identified 159 patients (52% female) presenting to colorectal surgery clinic. Based on self-reporting, 20% of our cohort had a prior diagnosis of anorectal disease, and 19% of patients had previously been seen in a colorectal surgery clinic. The most common reasons for referral included hemorrhoids (57%), anal/rectal bleeding (29%), and anal/rectal pain (13%). Within our cohort, 42% underwent an anorectal exam prior to the colorectal visit. Of those who had been examined, 19% had a digital rectal examination, and 2% underwent anoscopy. Reasons for referral matched the diagnosis made in colorectal surgery clinic in 75 patients (47%). Nearly 40% of patients eventually underwent an anorectal procedure, the majority of which occurred in the operating room (87%).

Conclusion/Discussion: In our exploratory analysis, only 40% of patients presenting to the colorectal surgery clinic had undergone an anorectal exam for their given anorectal complaint. These findings demonstrate important referral patterns and knowledge gaps. We plan to further explore these gaps with the goal of developing educational interventions and improving clinical systems to support referring clinicians in delivering prompt and focused patient care.