Predicting the Unwelcome Return: Insights From a Cohort of Postoperative Haemorrhoid Patients

AIM: Recurrence after haemorrhoid surgery is a clinical concern, but the factors associated with recurrence have not yet been fully elucidated. In particular, the effects of external haemorrhoids and postoperative complications on long-term outcomes have not been clearly defined. This study aimed to identify the factors associated with haemorrhoid recurrence and recurrence-free survival following haemorrhoid surgery.METHODS: This retrospective cohort study included patients who underwent elective haemorrhoid surgery between January 2021 and December 2023 at Dr. Soliman Fakeeh Hospital. We grouped the participants according to their recurrence status. Continuous variables were compared using the Mann–Whitney U test, while categorical variables were analysed using chi-square or Fisher’s exact tests, as appropriate. We assessed recurrence-free survival using Kaplan–Meier analysis with log-rank tests. Independent predictors of recurrence were identified using Cox proportional hazards regression analysis.RESULTS: A total of 529 patients were included, with a cumulative recurrence incidence of 4.3% (n = 23). Patients who developed recurrence were younger than those who did not (median age: 33 vs. 37 years, p = 0.025). There were also higher incidences of external haemorrhoids (30.4% vs. 14.0%, p = 0.030) and postoperative complications in the recurrence group (43.5% vs. 11.9%, p < 0.001). Kaplan–Meier analysis demonstrated significantly lower recurrence-free survival among patients who developed postoperative complications (log-rank p = 0.005). Patients with external haemorrhoids showed a trend towards lower recurrence-free survival, but the difference did not reach statistical significance (log-rank p = 0.151). In our multivariable Cox regression analysis, postoperative complications remained independently associated with recurrence risk (hazard ratio [HR] 4.63, 95% confidence interval [CI]: 1.68–12.80, p = 0.003). The association between external haemorrhoids and recurrence risk demonstrated borderline significance (HR 2.55, 95% CI: 0.99–6.60, p = 0.053).CONCLUSIONS: Postoperative complications were independently associated with earlier recurrence and poorer recurrence-free survival following haemorrhoid surgery. There was a trend towards increased recurrence risk in patients with external haemorrhoids, but the association did not remain statistically significant after adjustment. These findings may help identify patients at higher risk of recurrence and support more individualised postoperative follow-up strategies.