Unplanned re-hospitalizations in proctology. An update

Proctological surgery is widely practiced in France, with over 100,000 procedures recorded in 2022. More than half of patients are treated as outpatients. Re-admissions or conversion from outpatient surgery to in-patient status are not uncommon and can occur in up to 18% of cases. The main reasons for early readmission are pain, acute urinary retention, bleeding, constipation, infection, anal fissure or hemorrhoid thrombosis. Later re-admissions can also occur due to anal stenosis, anal incontinence, and delayed healing. Prevention of complications is therefore essential to avoid these readmissions. This is based primarily on preoperative patient education regarding signs that may require emergency consultation, as well as on the identification of those patients at risk of bleeding, acute urinary retention, and infectious complications. Intraoperatively, adherence to the quality criteria of proctological surgery is essential, ranging from the choice of techniques to the control of hemostasis and certain technical details, such as respecting mucosal bridges in patients undergoing tripedicular hemorrhoidectomy, or chemical or surgical sphincterotomy in the case of fissurectomy. Pre- and postoperative therapeutic education is essential, as the systematic preparation of prescriptions preoperatively, and software-based patient support (e.g. text message reminders).