Quality indicators in the treatment of hemorrhoids

Background: A quality indicator is a quantitative measure that can be used to monitor and evaluate the quality of certain operative procedures that may influence the result of a therapy. An indicator is not a direct measure of quality, it is merely atool to evaluate the performance of procedures and can indicate potential problem areas. Material and methods: A literature search was performed for parameters which could be included as indicators of quality in the treatment of hemorrhoids. Results and conclusion: In the treatment of benign diseases, such as hemorrhoids objective indicators (e.g. recurrence or survival rates in oncological diseases) cannot be used as quality indicators. Other indicators or core outcome factors must be used. From the patient's point of view other indicators are important (such as pain, complications, continence, days off work, etc.) than those for the colorectal surgeon, health insurance and healthcare provider. The most important indicators or outcome factors for treatment of hemorrhoids are postprocedural pain, patient satisfaction, complications, residual and recurrent symptoms, pain, quality of life, costs and duration of inability to work. In terms of outcome quality various quality indicators could be identified which also play a role in the guidelines; however, in this respect valid questionnaires or scores that enable a uniform assessment exist only in a few cases. In contrast, some indicators (e.g. costs, length of hospital stay) are strongly influenced by factors such as the healthcare system making these indicators unfeasible.