Parameters predicting postoperative pain and quality of life after hemorrhoidectomy: follow-up results from a prospective multicenter randomized trial

Abstract

Purpose: Pain and reduced quality of life (QoL) is a major subject of interest after surgery for hemorrhoids. The aim of this study was to find predictive parameters for postoperative pain and QoL after hemorrhoidectomy. Methods: This is a follow-up analysis of data derived from a multicenter randomized controlled trial including 770 patients, which examines the usefulness of tamponade after hemorrhoidectomy. Different pre-, intra- and postoperative parameters were correlated with Pain level assessed by NRS and QoL by the EuroQuol. Results: At univariate analysis, relevant (NRS > 5/10 pts.) early pain within 48 hours after surgery was associated with young age (p = 0.002), use of a tamponade (p < 0.001), relevant preoperative pain (p = 0.002), pudendal block (p < 0.001), and duration of surgery (p = 0.018). At multivariate analysis, young age (p = 0.009, OR 1.66), use of a tamponade (p = < 0.001, OR 1.7) and relevant preoperative pain (p = 0.042, OR 1.63) predicted relevant early postoperative pain whereas pudendal block protected (p < 0.001, OR 2.67). Persisting relevant pain on day 7 was associated with relevant early pain (p < 0.001) and duration of surgery (p = 0.030). QoL overall remained at the same level. However, n = 229 (33%) patients presented an improvement of QoL and n = 245 (36%) an aggravation. Improvement was associated with a reduction of preoperative higher pain levels after surgery (p < 0.001) and analgesia with opioids (p < 0.001). Conclusion Early relevant pain affects younger patients but can be prevented by avoiding tamponades and using a pudendal block. Persisting relevant pain is associated with longer duration of surgery. Relief in preexisting pain and opioids improve QoL. Registration number: DRKS00011590 12 April 2017.