Impact of Ambulatory Surgery for Hemorrhoidal Disease on Clinical Outcomes and Institutional Costs

Abstract

Objective Transanal hemorrhoidal artery ligation with mucopexy (ligation anopexy [LA]) and open hemorrhoidectomy (OH) can both be performed under local anesthesia. The aim of the present study was to analyze the impact and the cost-effectiveness of performing these techniques in an ambulatory setting of an Italian academic center on the postoperative outcome.

Methods A series of 122 consecutive patients with grades II and III hemorrhoidal disease undergoing ambulatory surgical treatment of hemorrhoids in 2015 to 2018 (group A) was compared with 122 patients operated at the same institution in the same period (group H) in a hospital setting.

The primary outcome was the number of days required to return to work/daily activities. Secondary outcomes included postoperative pain and complications, cost-effectiveness, patient satisfaction, and recurrence at 12 months. In group A, all the procedures were performed under local anesthesia with early discharge. In group H, the procedures were performed under general or loco-regional anesthesia with hospital admission.

Results The mean number of days required to return to work/daily activities was 8.4 ± 4.8 days in group A, compared with 12.5 ± 3 days in group H (p < 0.001). The visual analog scale (VAS) pain score at 1 week, 2 and 3 weeks, and 1 month after surgery was lower for patients undergoing LA in the ambulatory setting (p < 0.01). We observed more postoperative complications in hospitalized (12.5%) than in ambulatory patients (7.5%) (p < 0.001). The total mean direct costs per patient were significantly lower in the ambulatory setting versus the hospital stay group (351.3 versus 1,746 euros).

Conclusion Implementing ambulatory surgery for hemorrhoids is feasible, safe, and cost-effective.

Resumo

Objetivo A ligação transanal da artéria hemorroidária com mucopexia e a hemorroidectomia aberta (HA) podem ser realizadas em anestesia local. O objetivo do presente estudo foi analisar o impacto no resultado pós-operatório e a relação custo-eficácia da realização destas técnicas em ambiente ambulatorial de um centro acadêmico italiano no desfecho pós-operatório.

Métodos Uma série de 122 pacientes consecutivos com patologia hemorroidária de graus II e III submetidos a cirurgia de hemorroidas em regime ambulatório de 2015 a 2018 (grupo A) foi comparada com 122 pacientes operados na mesma instituição no mesmo período (grupo H) por hospitalização.

O desfecho primário foi o número de dias necessários para regressar ao trabalho/atividades diárias. Os desfechos secundários incluíram dor e complicações pós-operatórias, custo-eficácia, satisfação do paciente, e recidiva aos 12 meses. No grupo A, todos os procedimentos foram realizados em anestesia local. No grupo H, os procedimentos foram realizados em anestesia geral ou loco-regional.

Resultados A espera média para o regresso ao trabalho foi de 8,4 ± 4,8 dias no grupo A em comparação com 12,5 ± 3 dias no grupo H (p < 0,001). A pontuação na escala visual analógica (EVA) da dor 1 semana, 2 e 3 semanas, e 1 mês após a cirurgia foi mais baixa para os pacientes submetidos a cirurgia de ligadura com anopexia em ambiente ambulatorial (p < 0,01). Observamos mais complicações pós-operatórias em pacientes hospitalizados (12,5%) do que em pacientes ambulatórios (7,5%) (p < 0,001). Os custos diretos médios totais por paciente foram mais baixos em ambiente ambulatório do que no grupo de hospitalização (351,3 contra 1.746 euros).

Conclusão A implementação da cirurgia ambulatória para hemorroidas é possível, segura e rentável.

Keywords

hemorrhoids - hemorrhoidectomy - transanal hemorrhoroidal dearterialization - local anesthesia - ligation anopexy - ambulatory surgery

Palavras-chave

hemorroidas - hemorrhoidectomia - dearterialização hemorroidária transanal - anestesia local - anopexia - cirurgia ambulatória

Authorship

Simona Ascanelli: Study conception and design; acquisition, analysis, or interpretation of data; drafting and critical revision of the work for important intellectual content; and final approval of the version to be published.

Stefano Solari: Acquisition, analysis, or interpretation of data; drafting and critical revision of the work for important intellectual content; and final approval of the version to be published.

Michele Rubbini: Critical revision of the work for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Filippo Aisoni: Acquisition, analysis, or interpretation of data; critical revision of the work for important intellectual content; and final approval of the version to be published.

Elena Forini: Acquisition, analysis, or interpretation of data; critical revision of the work for important intellectual content; and final approval of the version to be published.

Paolo Carcoforo: Study conception; critical revision fo the work for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Publication History

Received: 08 July 2020

Accepted: 10 August 2020

Article published online:
19 March 2021

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