EP512 - Decisional Regret and Patient Reported Outcomes Following Hemorrhoidectomy: A Survey Study

Purpose/Background: Hemorrhoidectomy is the mainstay for definitive treatment of symptomatic hemorrhoids; however, post-operative pain and recovery is notoriously challenging. While post-operative outcomes have been well-studied, relatively little is known about the patient experience. Our goal is to understand the patient perspective following hemorrhoidectomy, including factors associated with decisional regret, in order to better inform patient and surgeon decision-making.

Methods/Interventions: This is a single-institution survey study of patients who previously underwent hemorrhoidectomy between 4/11/2024 - 3/11/2025. Chart review was performed to collect demographics, indication for surgery, and operative details. Phone interviews in the patient's native language were conducted to collect survey data. The survey included the Decision Regret Scale (DRS), a validated questionnaire used to detect regret after medical decisions. We defined an "Explicit Regret Group" as patients who responded Neutral to Strongly Disagree on "It was the right decision to have hemorrhoid surgery", or Neutral to Strongly Agree on "I regret the decision to have surgery". Additionally, patients were asked open-ended questions about their recovery and associated symptoms. Descriptive statistics were used to compare responses.

Results/Outcomes: Of 126 eligible participants, 49 were able to be contacted (38.9%). Median age at procedure was 45 years and of the cohort, 23 (46.9%) were female and 26 were male (53%). Half (51%) of patients were called within 3 months of their procedure, 24% between 3-6 months, and the remainder after 6 months. Excision was performed with electrocautery alone in 63% of cases, Ligasure alone in 33%, and both in 5%. Suture was used intraoperatively in 39% for hemostasis or closure, and hemorrhoid banding was performed concurrently in 12%. Of the respondents, 6 (12%) had no regret (DRS value of 0), 29 (59%) had mild regret (DRS values 1-25), 14 (29%) had moderate regret (DRS values 26-65) and none had severe regret (DRS values 66-100). Seven patients met the criteria for explicit regret, of which 5 had some degree of leakage/incontinence, 2 mentioned significant postoperative bleeding, 4 had persistent pain and 2 reported hemorrhoid recurrence.

Conclusion/Discussion: We found that patients who reported significant persistent symptoms following hemorrhoidectomy, such as leakage and pain, and had higher regret scores. While the study was limited by a small sample size, our findings suggest a need for longitudinal assessment of decisional regret, as this is a fluid concept. This foundational work can be used for future prospective studies to assess the impact of improved preoperative counseling interventions to better prepare patients for their operation.

Table 1
Table 1: Results from the five-question Decision Regret Scale. A score of 0 indicates no regret, scores of 1-25 indicate mild regret, 26-65 indicate moderate regret, and 66-100 indicate severe regret.