Impacto da cirurgia ambulatória para patologia hemorroidária nos resultados clínicos e custos

Simona Ascanelli

Department of Morphology, Surgery and Experimental Medicine, Università degli Studi di Ferrara, Ferrara, Italy

Stefano Solari

Department of Morphology, Surgery and Experimental Medicine, Università degli Studi di Ferrara, Ferrara, Italy

Michele Rubbini

Department of Morphology, Surgery and Experimental Medicine, Università degli Studi di Ferrara, Ferrara, Italy

Filippo Aisoni

Department of Morphology, Surgery and Experimental Medicine, Università degli Studi di Ferrara, Ferrara, Italy

Maria Elena Forini

Health Statistics Office, Università degli Studi di Ferrara, Ferrara, Italy

Paolo Carcoforo

Department of Morphology, Surgery and Experimental Medicine, Università degli Studi di Ferrara, Ferrara, Italy

Address for correspondence Stefano Solari, MD, Department of Morphology, Surgery and Experimental Medicine, Section General Surgery, Azienda Ospedaliero-Universitaria Arcispedale S. Anna, Ferrara. Via Aldo Moro 8, Cona - Ferrara, 44124, Italy (e-mail: slrsfn@unife.it).

Authorship

Simona Ascanelli: Study conception and design; acquisition, analysis, or interpretation of data; drafting and critical revision of the work for important intellectual content; and final approval of the version to be published. Stefano Solari: Acquisition, analysis, or interpretation of data; drafting and critical revision of the work for important intellectual content; and final approval of the version to be published.Michele Rubbini: Critical revision of the work for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of thework, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Filippo Aisoni: Acquisition, analysis, or interpretation of data; critical revision of the work for important intellectual content; and final approval of the version to be published. Elena Forini:Acquisition, analysis, or interpretation ofdata; critical revision of the work for important intellectual content; and final approval of the version to be published. Paolo Carcoforo: Study conception; critical revision fo the work for important intellectual content; final approval of the version to be published; and agreement to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Variable	Group AAmbulatory	Group HHospitalized	P-value
Age (mean ± SD)	54.07 ± 12.07	53.16 ± 11.8	NS
Females (N. %)	74 (61.7)	61 (50.8)	NS
Males (N, %)	46 (38.3)	59 (49.2)	NS
Body Mass Index (Kg/m2) (N, %)			NS
< 25	100 (83.3)	97 (80.8)
25–29.9	17 (14.2)	20 (16.7)
> 30	3 (2.5)	3 (2.5)
American Society of Anesthesiascore (N. %)			NS
ASA I	73 (60.8)	71 (59.2)
ASA II	39 (32.5)	39 (32.5)
ASA III	38 (6.7)	10 (8.3)
Work activity (N, %)	103 (85.8)	102 (85)	NS
Previous surgeryfor hemorrhoids (N, %)	6 (5)	12 (10)	NS
Grade 2 hemorrhoids (N, %)	54 (45)	50 (41.7)	NS
Grade 3 hemorrhoids (N, %)	66 (55)	70 (58.3)	NS
Number of piles			NS
1	9	5
2	30	36
3	63	63
4	10	7
5	8	9
LA (N, %)	62 (54.4)	52 (45.6)	NS
OH (N, %)	58 (46)	68 (54)	NS
Length of follow-up (months) (mean ± SD)	26.3 ± 11.3	29.6 ± 14.4	NS

	Ambulatory			Hospitalized			P-value
	Group A120	LA62	OH58	Group H120	LA52	OH68
Length of procedure (min)Mean ± SD	27.5 ± 9.3	22.2 ± 6.6	33.7 ± 7.9	32.4 ± 8.4	28.9 ± 8.4	35.07 ± 7.5	< 0.001
Hospital length of stay (hours)Median (range)	1 (1–2)	1 (1–2)	1 (1–3)	10 (8–120)	10 (8–28)	27 (9–120)	< 0.001
Return to work/daily activities (days)Mean ± SD	8.4 ± 4.8	8.5 ± 4.7	8.4 ± 4.9	12.5 ± 3	12.05 ± 2.9	12.9 ± 3.04	< 0.001
HD recurrence at 12 months (N, %)	5 (4.2)	4 (6.4)	1 (1.7)	4 (3.3)	4 (7.7)	−	< 0.01
Reoperation after 12 months (N, %)	3 (2.5)	3 (4.8)	−	2 (1.6)	2 (3.8)	−	NS
HD recurrence at 24 months (N, %)	3 (2.5)	3 (4.8)	−	2 (1.6)	2 (3.8)	−	NS

	Ambulatory			Hospitalized			P-value
	Group A120	LA62	OH58	Group H120	LA52	OH68
Overall postoperative complications(Clavien-Dindo)(N, %)	9 (7.5)	5 (8.1)	4 (6.9)	15 (12.5)	9 (17.3)	6 (8.8)	< 0.001
Grade I	9 (7.5)	5 (8.1)	4(6.8)	14 (11.7)	9 (17.3)	5 (7.3)	< 0.01
Grade Iurinary retention	1 (0.8)	−	1 (1.7)	7 (5.8)	4 (7.7)	3 (4.4)	< 0.01
Grade I	8(6.6)	5(8.1)	3 (5.1)	7 (5.8)	5 (9.6)	2 (2.9)	NS
Anal complications
Bleeding	−	−	−	−	−	−
Thrombosed hemorrhoids	3 (2.5)	3 (4.8)	−	3 (2.5)	3 (5.7)	−	< 0.01
Prolapse	−	−	−	−	−	−	NS
Fissure	2 (1.6)	1 (1.6)	1 (1.5)	2 (1.6)	1 (1.9)	1 (1.5)	NS
Stenosis	−	−	−	−	−	−	NS
Impaction	1 (0.8)	−	1 (1.5)	−	−	−	NS
Local infection	1 (0.8)	1 (1.6)	−	1 (0.8)	1 (1.9)	−	NS
Urgency or mild incontinence	1 (0.8)	−	1 (1.5)	1 (0.8)	−	1 (1.5)	NS
Grade IIpersistent pain with prolonged hospital stay	0	−	−	1 (0.8)	−	1 (1.5)	NS

Variable	Ambulatory	Hospitalized	P-value
Operating room (pharmacy, equipment, staff, operating theater) (Euro)	275 ± 0	408 ± 182.0	< 0.001
Surgical ward (hospital stay, pharmacy, laboratory) (Euro)	0	1237.5 ± 262.7	< 0.001
Outpatient clinic visits (Euro)	76.33 ± 23.02	116 ± 32.14	< 0.001
Total mean institutional costs per patient (Euro)	351.3 ± 23	1746.4 ± 347.01	< 0.001

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