EP176 - Unplanned Emergency Department Utilization After Benign Anorectal Surgery: Incidence, Predictors, and Opportunities for Quality Improvement

Purpose/Background: Benign anorectal procedures such as hemorrhoidectomy, fissurectomy/lateral internal sphincterotomy (LIS), fistulotomy, and destruction of condyloma are common ambulatory colorectal operations. Despite their presumed low morbidity, minor and major complications may prompt increased utilization of clinic resources, unplanned emergency department (ED) visits, and unexpected reintervention. These encounters contribute to patient distress and healthcare utilization and are increasingly tracked quality metrics in colorectal surgery. This study aimed to determine the 30-day incidence, causes, and predictors of unplanned ED visits following benign anorectal surgery.

Methods/Interventions: A retrospective review was conducted of patients who underwent excisional hemorrhoidectomy, fissurectomy/LIS, fistulotomy, rectal advancement flap, or destruction of anal condyloma in 2024 at a large colorectal group operating across four hospitals. Demographic, perioperative, and postoperative data were collected from electronic medical records. The primary endpoint was unplanned ED visit within 30 days; secondary endpoints included telephone encounters, unplanned admission, reoperation, and mortality. Logistic regression identified independent predictors of ED visits.

Results/Outcomes: In total, 711 patients were included. Hemorrhoidectomy was the most common procedure (28.1%). Patients were predominantly male (57%), younger than 45 years (61% ), and classified as ASA I-II (87.8% ). The 30-day ED visit rate was 5.1%, and14.8% of patients had an early postoperative telephone encounter prior to their initial clinic visit. Of those who went to ED, 60% made a telephone call to clinic beforehand. The most common reasons for ED visits were bleeding (42%), pain (31%), and urinary retention (19%). Procedure type was the dominant predictor of ED utilization: hemorrhoidectomy (OR 7.31, p=0.004) and condyloma destruction (OR 8.85, p=0.007) were significantly associated with higher odds of ED presentation. Higher ASA, age, and anticoagulation were associated with higher odds of ED visit, though these findings were ultimately not significant.

Conclusion/Discussion: Unplanned ED visits occurred in approximately one in twenty patients after benign anorectal surgery, most often for bleeding or pain following hemorrhoidectomy or condyloma procedures. Procedure type was the strongest predictor of ED utilization, while patient comorbidities were not independently associated. Enhanced perioperative counseling, standardized pain and bleeding management pathways, and early proactive postoperative outreach may reduce preventable ED visits and improve the patient experience after outpatient anorectal operations.

30 day ED visit by procedure type
Patient demographics