Comparative Outcomes of Hemorrhoidectomy under Spinal Anesthesia between Older and Super-old Patients.

OBJECTIVES

With increasing life expectancy, the number of older and very old patients undergoing anorectal surgery is rising. However, concerns remain regarding the safety of hemorrhoidectomy among those aged ≥80 years. In this study, we compared postoperative outcomes between older (age 65-79 years) and very old (age ≥80 years) patients undergoing open hemorrhoidectomy under spinal anesthesia.

METHODS

This single-center retrospective cohort study included consecutive adult patients who underwent excisional hemorrhoidectomy between April 2024 and May 2025. Patients were stratified into older (65-79 years) and very old (≥80 years) groups. Baseline characteristics, perioperative factors, and postoperative outcomes, including 6-month complications, and predictors of Foley catheter insertion or additional analgesic injections were assessed.

RESULTS

Overall, 693 older patients and 68 very old patients were included. The incidence of early (≤6 months) postoperative complications, including constipation, bleeding, and recurrence, did not differ significantly between the two groups. Foley catheter insertion occurred more frequently in the very old group than in the older group (45.6% vs 31.0%, p = 0.021). No Clavien-Dindo grade III or higher complications occurred in the very old group. In the multivariable analysis, intravenous patient-controlled analgesia was associated with a reduced likelihood of needing additional analgesic injections (odds ratio, 0.39; 95% confidence interval, 0.22-0.69).

CONCLUSIONS

Hemorrhoidectomy under spinal anesthesia led to comparable short-term postoperative outcomes in older and very old patients without severe systemic disease.