Association between inflammatory markers and the risk of severe pain after mixed hemorrhoidectomy: A retrospective cohort study

Abstract Background The severe pain that may occur after hemorrhoidectomy exerts adverse effects on patients’ quality of life. This study aimed to explore the association between inflammatory markers and the risk of severe pain after hemorrhoidectomy in patients with mixed hemorrhoids. Methods This retrospective cohort study enrolled patients who underwent hemorrhoidectomy and had complete preoperative routine blood test data. Severe pain was defined as the Visual Analog Scale (VAS) score of ≥ 7 within 24 hours after surgery. Inflammatory indicators, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), were calculated. The association between inflammatory indicators (NLR, PLR, SII, SIRI) and severe pain risk was analyzed using logistic regression analysis. The latent class analysis (LCA) was used to cluster the ordered multi-class Short-Form McGill Pain Questionnaire (SF-MPQ) items in order to evaluate different categories of severe pain. Results A total of 561 patients with mixed hemorrhoids were enrolled for analysis. Of these patients, 389 (69.34%) experienced severe pain, while 172 (30.66%) patients did not. SIRI ≥ 13.29 (vs. SIRI < 13.29) was associated with a higher risk of severe pain [OR = 1.80 (95%CI: 1.19–2.75)]. No significant relationships were detected between severe pain and NLR ≥ 2.47 (vs. NLR < 2.47), PLR ≥ 8.78 (vs. PLR < 8.78), or SII ≥ 633.88 (vs. SII < 633.88). Through LCA, the pain patterns of patients with severe pain were grouped into three categories: Group 1 (shooting-stabbing-cramping pain and fearful), Group 2 (heavy-sickening discomfort profile), and Group 3 (throbbing-tiring-exhausting profile). Compared with Group 3, SIRI was found to be a risk factor for the occurrence of the Group 1 pain pattern in patients [SIRI (continuous): OR = 1.05 (95%CI: 1.01–1.09); SIRI ≥ 13.29: OR = 1.81 (95%CI: 1.01–3.27)]. Conclusion Higher SIRI levels were associated with an increased risk of severe pain in patients after mixed hemorrhoidectomy, and the influence of SIRI may vary across different pain patterns.