Sodergren Hemorrhoidal Symptom Severity Score as a Guide for Treatment of Hemorrhoidal Disease: A Cross-Sectional Study

Background and objectives Hemorrhoidal disease (HD) is a common anorectal condition affecting a large number of adults worldwide. Lack of standardized outcomes limits treatment decisions in HD. Patient-reported outcome measures (PROMs), directly reported by the patients, offer standardized, patient-centric measures, aiding in HD severity assessment and treatment decisions. The Sodergren score is one such PROM that has shown significant predictive ability for surgical decision-making in HD patients. The Aim of this study was to find a Sodergren hemorrhoidal symptom severity cut-off score to predict the need for surgical management in hemorrhoidal disease. Methodology All patients > 18 years of age diagnosed with HD presenting to the outpatient clinics in the Colorectal Unit, who gave their consent to participate, were included in the study. Patients with anal fistula, anal fissure, inflammatory bowel disease (IBD), colorectal malignancy, prior hemorrhoidal surgery, on antiplatelet therapy, and pregnancy were excluded. The sample size calculated was 34. Based on the treatment, the patients were divided into non-surgical (A) and surgical (B) groups (17 in each group). The patients were made to fill out the Sodergren hemorrhoidal symptom severity score questionnaire. The final Sodergren score was recorded for data analysis. Results Sodergren score was evaluated in 34 HD patients; 17 in each treatment group. A significant difference in Sodergren scores was found between the non-surgical group (median: 4; interquartile range (IQR) 0-4 ) and the surgical treatment group (median: 7 (IQR 4-10) (P=0.001). The Sodergren score demonstrated an area under the receiver operating characteristic curve (AUC) of 0.834 (95% CI: 0.702 - 0.966) for predicting surgical decision-making, with an optimal cut-off score of ≥7 (sensitivity:58.8; specificity:88.2). Conclusion Sodergren score demonstrated utility as a patient-reported severity assessment tool to guide treatment outcomes in HD patients. A cut-off score of ≥7 was predictive of surgery.