Risk factors associated with posthemorrhoidectomy secondary hemorrhage: A single-institution prospective study of 4,880 consecutive closed hemorrhoidectomies

PURPOSE: Posthemorrhoidectomy secondary hemorrhage is a rare but serious complication after hemorrhoidectomy. The determination of risk factors for this complication may provide information to improve outcome. A prospective study was conducted to determine the risk factors associated with posthemorrhoidectomy secondary hemorrhage. METHODS: We studied 4,880 patients who underwent an elective closed hemorrhoidectomy by 9 proctologists in a single institution between January 1994 and July 1996. The variables analyzed included age, gender, surgeon, surgeon's seniority, suture material, aseptic preparation, and use of antibiotics. The logistic regression model was used to assess the independent association of variables with posthemorrhoidectomy secondary hemorrhage. RESULTS: Among the 4,880 patients, 45 (0.9 percent) developed posthemorrhoidectomy secondary hemorrhage. The mean interval from operation to the onset of secondary hemorrhage was 8.8 (range, 5-19) days. Multivariate analysis revealed that patient's gender and individual surgeons were both independently associated with risk of hemorrhage. Male patients were more likely than females to develop posthemorrhoidectomy secondary hemorrhage (relative risk, 2.1; 95 percent confidence interval, 1.1-4.1; P = 0.021). The posthemorrhoidectomy secondary hemorrhage rates among individual surgeons ranged from 0.2 to 2.4 percent (P = 0.003). CONCLUSION: Our data suggest that male patients are more likely to develop posthemorrhoidectomy secondary hemorrhage than female patients and that intersurgeon variability is highly correlated with this risk.