title: Development and validation of a practical score to predict pain after excisional hemorrhoidectomy.
abstract: OBJECTIVE
  Excisional hemorrhoidectomy (EH) can be complicated by high early (EP) and prolonged pain (PP). This study aimed to determine predictors of high postoperative pain and to develop a risk score suitable to identify patient candidates to a more active analgesic treatment.
  
  
  METHODS
  We collected data of patients undergoing EH between January 2005 and September 2012 (development group). Patient-, disease-, surgery-, and surgeon-related characteristics were gathered. Anxiety was evaluated by means of STAI-Y. EP was assessed at 1-day, while PP at 15-day follow-up by means of a 10-cm VAS (cutoff, EP ≥ 5; PP ≥ 3 cm). On the basis of the odds ratio from a logistic regression, independent risk factors were assigned a weighted integer. The sum comprised the risk score, which was validated on a prospective cohort of patients undergoing EH between September 2012 and January 2014.
  
  
  RESULTS
  Five hundred fourteen patients were included in development group. Incidence of EP was 18.3 %, with 40.4 % developing PP. Younger age, male gender, advanced education, constipation, external component, anxious state and trait, and high anal resting tone were independent predictors of EP. Previous pain exerted a protective effect. Incomplete postoperative evacuation, advanced education level, high anal resting tone, and anxious trait were predictors of PP. In the development group, the risk of EP ranged between 1 % (low risk) and 21 % (high risk). Receiver operating curve (ROC) analysis of validation group (n = 130) confirmed the discriminatory power of this model (area under the ROC = 0.69).
  
  
  CONCLUSIONS
  The score can stratify the risk of EP following EH, identifying high-risk patient candidates to active analgesic administration or alternative surgical procedures.
authors.affiliation: Unit of General Surgery, Second University of Naples, Via F. Giordani, 42, 80122, Naples, Italy, fselvaggi@hotmail.com.
authors.forename: Francesco
authors.initials: F
authors.lastname: Selvaggi
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pellino
authors.forename: Guido
authors.initials: G
authors.lastname: Sciaudone
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Candilio
authors.forename: Silvestro
authors.initials: S
authors.lastname: Canonico
mesh_terms: D000328:Adult; D000367:Age Factors; D001003:Anal Canal / Q000502:physiology; D001007:Anxiety / Q000150:complications; D003248:Constipation / Q000150:complications; D004522:Educational Status; D005260:Female; D061865:Hemorrhoidectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D050177:Overweight / Q000150:complications; D010149:Postoperative Pain / Q000175:diagnosis*; D011312:Pressure; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors