Hemorrhoid Surgery in Seniors Holds Significant Mortality Risk

Older adults who undergo hemorrhoid surgery suffer increased morbidity 30 days after the procedure, and many die during the following year, according to a new study.

Researchers at the University of California, San Francisco (UCSF, USA) conducted a study that analyzed outcomes for 3,664 patients (65 years of age and older) who underwent hemorrhoid surgery between 2014 and 2016. The analysis included 916 nursing home residents (average age 81 years) who were matched in a 1:3 ratio with community-dwelling older adults on the basis of age, sex, race, and comorbidities. The data were extracted from Medicare claims and the Minimum Data Set for Nursing Home Residents.

The results showed that the nursing home residents had a significantly greater risk for adverse events. Nursing home residents were more likely to experience 30-day complications (53%), compared to the matched community-dwelling older adults (33%). They also had an increased risk for one-year mortality (25% versus 16%, respectively). In a subset of nursing home residents for whom more information was available, the researchers found that 32% experienced worsening fecal continence after surgery. The study was presented at the American Geriatrics Society (AGS) annual scientific meeting, held online during May 2021.

“The relatively increased risk for poor outcomes among nursing home residents is understandable, based on the degree of frailty that patients in the nursing home tend to have; frailty has been associated with worse outcomes after all types of surgery,” said lead author and study presenter Alexis Colley, MD. “But I think it is important that we are counseling our patients and thinking about the high rates of complications, and even mortality, for our frail nursing home patients when we evaluate them for potential hemorrhoidectomy.”

Hemorrhoids are vascular structures in the anal canal that aid in stool control. They become problematic when swollen or inflamed. Internal hemorrhoids often result in painless, bright red rectal bleeding when defecating. External hemorrhoids often result in pain and swelling in the area of the anus; if bleeding occurs, it is usually darker. usually, no specific treatment is needed. A number of minor procedures may be performed if symptoms are severe or do not improve with conservative management. Surgery is reserved for those who fail to improve following these measures.

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