Development of the HEMOS (Hemorrhoid Operative Selection) Score: A Clinical Tool to Support Operative Consideration in Hemorrhoid Patients

Development of the HEMOS (Hemorrhoid Operative Selection) Score: A Clinical Tool to Support Operative Consideration in Hemorrhoid Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Development of the HEMOS (Hemorrhoid Operative Selection) Score: A Clinical Tool to Support Operative Consideration in Hemorrhoid Patients Yoon-Hye Kwon This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7017509/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: To develop and validate the Hemorrhoid Operative Selection (HEMOS) score, a practical clinical scoring system that integrates anatomical findings, symptom severity, and quality of life impact to support evidence-based surgical decision-making in patients with symptomatic hemorrhoidal disease. Methods: This retrospective, single-center study included 234 patients with symptomatic hemorrhoids treated at Uijeongbu Eulji Medical Center between January 2023 and December 2024. Clinical variables assessed were hemorrhoid grade, prolapse severity, bleeding, transfusion requirement, pain, and quality of life impact. The primary outcome was surgical intervention. Multivariable logistic regression identified independent predictors of surgery, which were used to construct the HEMOS score. Model performance was evaluated using receiver operating characteristic (ROC) curve analysis. Results: Forty patients (17.1%) underwent surgery. Four independent predictors were identified: grade III–IV hemorrhoids, frequent or irreducible prolapse, transfusion-requiring bleeding, and moderate-to-severe quality of life impact. The HEMOS score (range 0–8) demonstrated excellent discrimination (AUC 0.896), with a cut-off of ≥4 yielding 95.0% sensitivity and 74.2% specificity for predicting surgical intervention. Conclusions: The HEMOS score provides a practical, internally validated tool that systematically integrates key clinical variables to support surgical decision-making in hemorrhoidal disease. Further multicenter studies are warranted to externally validate its performance and confirm broader applicability. Hemorrhoids Scoring System Treatment Decision-Making Surgical Intervention Quality of Life Prediction Model Figures Figure 1 Figure 2 Introduction Hemorrhoidal disease is one of the most common benign anorectal conditions, with prevalence rates ranging from 4.4% to 38% depending on population demographics and diagnostic criteria [1, 2]. In South Korea, the prevalence of hemorrhoids diagnosed by physicians was 7.2% [3], with hemorrhoidectomy ranks as the third most common surgery according to the 2023 National Statistics Report by the National Health Insurance Service [4]. This substantial healthcare burden highlights the importance of establishing evidence-based criteria for surgical decision-making. Patients with hemorrhoidal disease present with a wide spectrum of symptoms, ranging from mild discomfort to severe prolapse requiring surgical intervention. However, treatment decisions remain largely subjective and are often based solely on anatomical grading. The Goligher classification, developed over five decades ago, remains the standard staging system but focuses exclusively on prolapse severity, failing to incorporate critical clinical variables such as symptom burden, quality-of-life impact, and treatment response [5]. Several studies have reported poor correlation between anatomical grade and functional impairment [6-8]. Despite the complexity of clinical presentations, no validated scoring system currently exists that integrates anatomical, symptomatic, and patient-reported data to guide surgical decision-making. While existing clinical guidelines provide general recommendations, structured tools to support consistent and individualized decision-making remain limited [9, 10]. This gap contributes to substantial inter-clinician variability and hinders evidence-based counseling. To address these gaps, we developed a practical clinical scoring system, the Hem orrhoid O perative S election (HEMOS) score, that systematically integrates multiple clinical variables to support individualized surgical decision-making in patients with symptomatic hemorrhoidal disease. This study aims to describe the development and validation of the HEMOS score. Materials and method Study Design and Population This retrospective, single-center, observational study was conducted at Uijeongbu Eulji Medical Center between January 2023 and December 2024. We systematically reviewed electronic medical records of consecutive patients presenting to the outpatient colorectal clinic with anorectal symptoms. Patients with symptomatic hemorrhoidal disease, as diagnosed by clinical examination and confirmed by a board-certified colorectal surgeon, were included in the analysis. Exclusion criteria included a history of colorectal or anal malignancy, inflammatory bowel disease (Crohn’s disease or ulcerative colitis), or previous hemorrhoidectomy performed within the preceding 3 months to minimize confounding from recent surgical intervention. Patients with asymptomatic hemorrhoids discovered incidentally during evaluation or with incomplete clinical documentation were also excluded. All patients underwent standardized clinical evaluation by a single board-certified colorectal surgeon with over 10 years of experience in anorectal disease. Clinical variables were systematically collected using standardized case report forms. Primary variables included hemorrhoid grade according to Goligher's classification (Grade I-IV), prolapse severity categorized as none, occasional (with straining), frequent (with minimal straining), or irreducible, and bleeding severity assessed by patient-reported symptoms and documented anemia. Transfusion requirement was defined according to institutional protocol as the need for packed red blood cell transfusion in the context of hemorrhoid-related bleeding, typically associated with hemoglobin levels <7.0 g/dL. This threshold was chosen in line with restrictive transfusion strategies recommended by current guidelines. Additional variables included anal pain, bowel habits, and quality of life impact assessed using a 4-point scale (none, mild, moderate, severe). Prior hemorrhoidectomy, fecal incontinence, comorbidities, medication use, and treatment preferences were also recorded. All variables were assessed at the baseline outpatient visit during the initial evaluation by the colorectal surgeon. The primary outcome was surgical intervention (hemorrhoidectomy) following initial clinical evaluation. Treatment decisions were made by a single board-certified colorectal surgeon based on comprehensive clinical assessment, including symptom severity, anatomical findings, and patient preference. All surgical procedures were performed using standardized semi-closed hemorrhoidectomy technique. We acknowledge that using surgeon's decision as the primary outcome introduces inherent bias, as the prediction model reflects individual practice patterns rather than universally objective surgical indications. Statistical Analysis Continuous variables were expressed as means ± standard deviations (SD), and categorical variables as frequencies and percentages. Between-group comparisons used Student’s t-test for continuous variables and the chi-square test or Fisher’s exact test for categorical variables. Multivariable logistic regression analysis was performed using forward stepwise selection (p-entry 0.10). Variables with p<0.10 in univariable analysis were included in the initial multivariable model. The HEMOS score was developed by converting regression coefficients to integer points using proportional scaling. The variable with the highest coefficient (hemorrhoid grade) was assigned 3 points, and other variables were scaled accordingly. A maximum of 3 points per variable was chosen to facilitate intuitive interpretation while preserving the relative weight of each predictor. The model’s discriminatory performance was evaluated using the area under the receiver operating characteristic curve (AUC), and calibration was assessed using the Hosmer–Lemeshow goodness-of-fit test. The optimal cut-off score was determined using Youden's [11], which identifies the threshold that best distinguishes surgical from non-surgical cases. Internal validation was performed using 5-fold cross-validation repeated 10 times. All statistical analyses were conducted using SPSS version 25.0 (IBM Corp., Armonk, NY) for descriptive statistics and logistic regression analysis, and Python 3.9 for ROC analysis and cross-validation. Two-sided p-values <0.05 were considered statistically significant. Ethics Approval This study was approved by the Institutional Review Board of Uijeongbu Eulji Medical Center (IRB number UEMC 2025-05-002). Informed consent was waived due to the retrospective nature and use of de-identified data. The study was conducted in accordance with the Declaration of Helsinki. Results Baseline Characteristics A total of 234 patients with symptomatic hemorrhoidal disease were included in this study. The mean age was 54.15 ± 14.34 years, and 140 (59.8%) were female. Table 1 summarizes the baseline characteristics. Hemorrhoidal bleeding was present in 138 patients (59.0%), and 10 patients (4.3%) required red blood cell transfusion for anemia, defined as hemoglobin <7.0 g/dL. Regarding prolapse, 36 patients (15.4%) reported no prolapse, 121 patients (51.7%) had occasional prolapse, 70 patients (30.0%) had frequent prolapse, and 7 patients (3.0%) had irreducible prolapse. Anal pain during defecation was reported by 79 patients (33.8%), and persistent pain in 9 patients (3.8%). Quality of life impairment was distributed as 12 patients (5.1%) had no impairment, 143 (61.1%) had mild impairment, 67 (28.6%) had moderate impact, and 12 (5.1%) had severe impairment. According to Goligher's classification, 36 patients (15.4%) were grade I, 67 (28.6%) grade II, 113 (48.3%) grade III, and 18 (7.7%) grade IV. Constipation was reported by 31.6% of patients, fecal incontinence by 5.6%, and 9.8% had undergone previous hemorrhoidectomy. Anticoagulation therapy was noted in 11.1% of the cohort. Treatment Outcomes and Predictive Factors Among the 234 patients, 40 (17.1%) underwent hemorrhoidectomy while 194 (82.9%) were managed conservatively with dietary modification, warm water sitz bath, and topical agents. Univariate analysis demonstrated significant differences between the surgical and non-surgical groups in hemorrhoid grade (p<0.001), prolapse severity (p<0.001), anal pain (p=0.039), transfusion requirement (p=0.005), and quality of life impact (p<0.001) (Table 2). Age, sex, and use of anticoagulation were not significantly associated with surgical intervention. Although fecal incontinence and a history of previous hemorrhoidectomy were more common in the non-surgical group, these differences did not reach statistical significance. Multivariable logistic regression analysis identified four independent predictors of surgical intervention (Table 3). Grade III-IV hemorrhoids were most strongly associated with surgery (OR 9.81, 95% CI 2.18-44.10; p=0.003), followed by transfusion-requiring bleeding (OR 6.13, 95% CI 1.15-32.65; p=0.034), frequent or irreducible prolapse (OR 5.21, 95% CI 2.12-12.81; p<0.001), and moderate-to-severe quality of life impact (OR 2.92, 95% CI 1.25-6.82; p=0.013). The model demonstrated good fit (Hosmer-Lemeshow test χ²=6.82, p=0.525) and accounted for 42.1% of the variance in surgical decisions (Nagelkerke R²=0.421). Development and Performance of HEMOS Score A clinical scoring system was developed based on the final multivariable logistic regression model (Table 4). Points were allocated to each variable in proportion to the magnitude of its regression coefficient: hemorrhoid grade III–IV was assigned 3 points, frequent or irreducible prolapse 2 points, transfusion history 2 points, and moderate-to-severe quality of life impact 1 point. The total HEMOS score thus ranged from 0 to 8, providing a simple additive tool to stratify patients according to their likelihood of requiring surgical intervention. Receiver operating characteristic (ROC) curve analysis demonstrated excellent discriminative ability, with an area under the curve (AUC) of 0.896 (Figure 1). An optimal cut-off score of 4.0 was selected based on the maximum Youden index (0.692), with detailed sensitivity, specificity, and Youden index values across all cut-offs provided in Supplementary Table 1. At this threshold, the HEMOS score achieved a sensitivity of 95.0%, specificity of 74.2%, and an overall accuracy of 77.8% for predicting surgical intervention. The confusion matrix (Table 5, Supplementary Figure 1) showed 38 true positives, 2 false negatives, 50 false positives, and 144 true negatives. The HEMOS score demonstrated clear discrimination across different score ranges. Patients with scores of 0-3 exhibited low surgery rates (1.2-1.7%), whereas those with scores ≥6 had substantially higher surgery rates (57.4%), with intermediate groups showing a graduated increase (Figure 2). This distribution supports the score's potential clinical utility as a decision-support tool in routine practice. Internal validation using five-fold cross-validation yielded a mean AUC of 0.900 (range, 0.83–0.98) and a mean accuracy of 81.5%, indicating robust performance and reproducibility of the HEMOS score. Detailed performance metrics for each fold are provided in Supplementary Table 2. Discussion Several scoring systems have been developed to assess hemorrhoidal disease, each with distinct strengths and limitations. The Golliger classification [5], while widely adopted, only assesses the extent of prolapse, without considering other important symptomatic and functional aspects such as bleeding, pain, or quality of life impact. Multiple studies have demonstrated significant interobserver variability in Goligher classification application, raising concerns about clinical reliability [6, 12]. The lack of detailed anatomical descriptions in the Goligher system hinders the expression of true disease severity and often leads to inaccurate classification [13]. More comprehensive systems such as the COS [14], Shanmugam score [15] and Gerjy score [16] have incorporated additional clinical variables but were primarily designed for postoperative assessment or limited to surgical cohorts. Newer classification systems including BPRST [17], Sodergren [18], PATE systems [19, 20] and PROM-HISS [21] have attempted to provide a broader symptom integration, but none has achieved universal adoption due to complexity, limited validation, or narrow applicability. The HEMOS score was developed to address a specific gap in clinical practice - the absence of a standardized and practical tool for preoperative surgical decision-making. Unlike existing systems that focus primarily on symptom assessment or postoperative outcomes, HEMOS score specifically targets the surgical decision-making process through systematic integration of multiple clinically relevant variables. This study introduces the first validated scoring system specifically designed to standardize surgical decision-making in symptomatic hemorrhoidal disease. The inclusion of quality of life impact as a weighted variable emphasizes the importance of patient-reported outcomes in surgical decision-making, aligning with contemporary patient-centered care paradigms [7, 21]. This represents a significant advancement beyond purely anatomical criteria toward functional and experiential measures of disease burden. Recent studies have consistently demonstrated that patients with high symptom burden experience significantly reduced quality of life compared to the general population, and importantly, that anatomical grading does not reflect the disease burden experienced by patients. The integration of quality of life measures into surgical decision-making algorithms represents a crucial step toward more comprehensive patient care in hemorrhoidal disease [7]. Transfusion-requiring bleeding, though affecting only 4.3% of our cohort, emerged as a strong surgical predictor (OR 6.13). This finding underscores that severe bleeding complications, while uncommon, represent important surgical indications regardless of anatomical grade. Emergency surgery for hemorrhoidal disease is rare in general practice, but is essential when severe bleeding and anemia are present. Previous studies [22, 23] have documented hemorrhoids as sources of massive bleeding requiring emergency intervention, supporting the inclusion of transfusion history as a high-weighted variable. These results confirm that even in the absence of high-grade prolapse, severe bleeding should be considered an essential component of surgical treatment. This again emphasizes the importance of incorporating clinically significant events into decision-making algorithms. The HEMOS score's practical design enables rapid application in outpatient settings using standard clinical information without additional diagnostic workup. It is a simple integer scale from 0 to 8 that can be quickly applied in clinical practice. The simple 0-8 integer scale with an optimal cutoff of 4.0 provides clinicians with an objective framework for surgical consideration while maintaining high sensitivity (95.0%) to avoid missing surgical candidates. This study has several important limitations that require careful consideration. The single-center, single-surgeon design introduces potential bias reflecting individual practice patterns rather than universal surgical necessity. We acknowledge this inherent limitation - the scoring system predicts surgical likelihood in this specific clinical setting rather than providing absolute criteria for surgical need. This inherent limitation reflects the fact that the model may mirror the practice patterns of a single surgeon, rather than universal surgical necessity. However, this limitation paradoxically reflects the reality that motivated this study's design. The absence of standardized, evidence-based criteria for surgical decision-making in hemorrhoidal disease is precisely what leads to significant inter-physician variability in treatment recommendations. The HEMOS score provides a structured framework for documenting and standardizing these decisions, even though it may initially reflect individual practice patterns. The retrospective design limits control for confounding variables, and the relatively small sample size with low surgical rate (17.1%) may affect estimate precision. Additionally, not all patients underwent laboratory confirmation of anemia, as routine testing is not standard practice for hemorrhoidal symptoms [24]. While this reflects typical clinical workflow, it may introduce misclassification bias for transfusion-related variables. Finally, there are patients who initially managed conservatively may later require surgery, and some recommended for surgery may be lost to follow-up or decline intervention. This temporal variability in treatment decisions represents an inherent limitation in hemorrhoidal disease research. Despite these limitations, the study demonstrates notable strengths including consecutive patient recruitment, standardized assessment protocols, and rigorous statistical methodology. The scoring model balances accuracy with clinical usability, making it suitable for immediate practical application while serving as a foundation for future validation studies. External validation through multicenter studies incorporating diverse patient populations and practice settings is essential to confirm the HEMOS score's generalizability. Such validation should evaluate performance across different demographic subgroups and healthcare systems to establish broader clinical utility. The score's applicability to various interventional procedures beyond traditional hemorrhoidectomy, such as rubber band ligation, Doppler-guided ligation, and stapled hemorrhoid fixation, requires further investigation. Prospective trials evaluating long-term outcomes, including symptom recurrence, patient satisfaction, and quality of life improvement, would strengthen evidence for the score's clinical utility. Cost-effectiveness analyses could further elucidate the health economic impact of implementing standardized decision-making tools in hemorrhoidal disease management. Conclusion The HEMOS score provides a practical and internally validated tool to support surgical decision-making in patients with symptomatic hemorrhoidal disease. By systematically integrating anatomical findings, symptom severity, and quality of life impact, this scoring system offers an evidence-based framework that may help reduce variability in treatment recommendations. Further multicenter studies are warranted to externally validate the HEMOS score and confirm its broader applicability across diverse clinical settings. Declarations Funding : No funds, grants, or other support was received Conflicts of interest/Competing interests : The authors declare no conflicts of interest regarding this study Ethics approval : This study was approved by the Institutional Review Board of Uijeongbu Eulji Medical Center (IRB number UEMC 2025-05-002) Consent to participate : Informed consent was waived by the board Consent for publication : Not applicable Data availability: The datasets used and/or analysed during the current study available from the corresponding author on reasonable request Authors' contributions : Yoon-Hye Kwon designed the study, analyzed the data and wrote the manuscript References Riss S, Weiser FA, Schwameis K, Riss T, Mittlbock M, Steiner G, Stift A (2012) The prevalence of hemorrhoids in adults. Int J Colorectal Dis 27 : 215-220 Sun Z, Migaly J (2016) Review of Hemorrhoid Disease: Presentation and Management. Clin Colon Rectal Surg 29 : 22-29 Lee JH, Kim HE, Kang JH, Shin JY, Song YM (2014) Factors associated with hemorrhoids in korean adults: korean national health and nutrition examination survey. Korean J Fam Med 35 : 227-236 Service NHI (2024) 2023 National Statistics Report on Major Surgeries. Wonju, Korea Goligher JC DH, Nixon HH (1984) Surgery of the Anus, Rectum and Colon, 5th ed. edn, Baillière Tindall, London Dekker L, Han-Geurts IJM, Grossi U, Gallo G, Veldkamp R (2022) Is the Goligher classification a valid tool in clinical practice and research for hemorrhoidal disease? Tech Coloproctol 26 : 387-392 Longchamp G, Liot E, Meyer J, Longchamp A, Toso C, Buchs NC, Ris F (2020) Scoring systems as outcomes assessment of the treatments for haemorrhoidal disease: a systematic review of the literature. Int J Colorectal Dis 35 : 1015-1024 Rubbini M, Ascanelli S (2019) Classification and guidelines of hemorrhoidal disease: Present and future. World J Gastrointest Surg 11 : 117-121 Simillis C, Thoukididou SN, Slesser AA, Rasheed S, Tan E, Tekkis PP (2015) Systematic review and network meta-analysis comparing clinical outcomes and effectiveness of surgical treatments for haemorrhoids. Br J Surg 102 : 1603-1618 Trompetto M, Clerico G, Cocorullo GF, Giordano P, Marino F, Martellucci J, Milito G, Mistrangelo M, Ratto C (2015) Evaluation and management of hemorrhoids: Italian society of colorectal surgery (SICCR) consensus statement. Tech Coloproctol 19 : 567-575 Fluss R, Faraggi D, Reiser B (2005) Estimation of the Youden Index and its associated cutoff point. Biom J 47 : 458-472 Elbetti C, Giani I, Novelli E, Fucini C, Martellucci J (2015) The single pile classification: a new tool for the classification of haemorrhoidal disease and the comparison of treatment results. Updates Surg 67 : 421-426 Wang L, Ni J, Hou C, Wu D, Sun L, Jiang Q, Cai Z, Fan W (2023) Time to change? Present and prospects of hemorrhoidal classification. Front Med (Lausanne) 10 : 1252468 van Tol RR, Kimman ML, Melenhorst J, Stassen LPS, Dirksen CD, Breukink SO, Members of the Steering G (2019) European Society of Coloproctology Core Outcome Set for haemorrhoidal disease: an international Delphi study among healthcare professionals. Colorectal Dis 21 : 570-580 Shanmugam V, Watson AJ, Chapman AD, Binnie NR, Loudon MA (2005) Pathological audit of stapled haemorhoidopexy. Colorectal Dis 7 : 172-175 Gerjy R, Derwinger K, Lindhoff-Larson A, Nystrom PO (2012) Long-term results of stapled haemorrhoidopexy in a prospective single centre study of 153 patients with 1-6 years' follow-up. Colorectal Dis 14 : 490-496 Sobrado CW, de Almeida Obregon C, Sobrado LF, Bassi LM, Bacchi Hora JA, Silva ESJAH, Nahas SC, Cecconello I (2021) The novel BPRST classification for hemorrhoidal disease: A cohort study and an algorithm for treatment. Ann Med Surg (Lond) 61 : 97-100 Sha HL, Roslani AC, Poh KS (2020) Evaluating the ability of the Sodergren score to guide the management of internal haemorrhoidal disease. Colorectal Dis 22 : 1379-1387 Gaj F, Trecca A (2004) [PATE 2000 Sorrento: a modern, effective instrument for defining haemorrhoids. A multicentre observational study conducted in 930 symptomatic patients]. Chir Ital 56 : 509-515 Gaj F, Trecca A (2007) [New "PATE 2006" system for classifying hemorrhoidal disease: advantages resulting from revision of "PATE 2000 Sorrento"]. Chir Ital 59 : 521-526 Kuiper SZ, Kimman ML, Van Tol RR, Waardenburg SF, Van Kuijk SMJ, Dirksen CD, Breukink SO (2022) Patient reported outcome measure-haemorrhoidal impact and satisfaction score (PROM-HISS): Development, reliability and construct validity. Colorectal Dis 24 : 992-999 Krebs ED, Zhang AY, Hassinger TE, Suraju MO, Berry PS, Hoang SC, Hedrick TL, Friel CM (2020) Preoperative bleeding requiring transfusion: An under-reported indication for hemorrhoidectomy. Am J Surg 220 : 428-431 Deng H, Fang X, Wang H, Li M (2024) Preoperative Blood Transfusion Requirements for Hemorrhoidal Severe Anemia: A Retrospective Study of 128 Patients. Med Sci Monit 30 : e943126 Fathallah N, Beaussier H, Chatellier G, Meyer J, Sapoval M, Moussa N, de Parades V (2021) Proposal for a New Score: Hemorrhoidal Bleeding Score. Ann Coloproctol 37 : 311-317 Tables Table 1. Baseline characteristics of patients with symptomatic hemorrhoidal disease Clinical characteristics (n=234) Age, years, mean ± SD 54.15 ± 14.34 Gender, n (%) Female 140 (59.8) Male 94 (40.2) Anticoagulation, n (%) 26 (11.1) Bleeding, n (%) 138 (59.0) Prolapse, n (%) None/Occasional 157 (67.1) Frequent/Irreducible 77 (32.9) Pain, n (%) During defecation 79 (33.8) Persistent 9 (3.8) Transfusion, n (%) 10 (4.3) QoL impact, n (%) None/Mild 155 (66.2) Moderate/Severe 79 (33.8) Constipation, n (%) 74 (31.6) Fecal incontinence, n (%) 13 (5.6) Previous hemorrhoidectomy, n (%) 23 (9.8) Grade, n (%) I 36 (15.4) II 67 (28.6) III 113 (48.3) IV 18 (7.7) Table 2. Univariate analysis of clinical factors associated with surgical intervention Non-surgical group (n=194) Surgical group (n=40) p-value Age, years, mean ± SD 53.91 ± 14.48 55.35 ± 13.73 0.563 Gender, n (%) 0.705 Female 115 (59.3) 25 (62.5) Male 79 (40.7) 15 (37.5) Anticoagulation, n (%) 22 (11.3) 4 (10.0) 0.806 Bleeding, n (%) 109 (56.2) 29 (72.5) 0.056 Prolapse, n (%) <0.001 None/Occasional 146 (75.3) 10 (25.0) Frequent/Irreducible 48 (24.7) 30 (75.0) Pain, n (%) 0.039 During defecation 63 (32.5) 16 (40.5) Persistent 5 (2.6) 4 (10.0) Transfusion, n (%) 5 (2.6) 5 (12.5) 0.005 QoL impact, n (%) <0.001 None/Mild 143 (73.7) 12 (30.0) Moderate/Severe 51 (26.3) 28 (70.0) Constipation, n (%) 65 (33.5) 9 (22.5) 0.173 Fecal incontinence, n (%) 12 (6.2) 1 (2.5) 0.354 Previous hemorrhoidectomy, n (%) 21 (10.8) 2 (5.0) 0.260 Grade, n (%) <0.001 I 36 (18.6) 0 (0.0) II 65 (33.5) 2 (5.0) III 84 (43.3) 29 (72.5) IV 9 (4.6) 9 (22.5) Table 3. Multivariable logistic regression analysis of factors associated with surgical intervention Univariate Multivariable OR 95% CI P-value Bleeding 0.056 0.149 Prolapse (Frequent/Irreducible vs None/Occasional) <0.001 5.21 2.12-12.81 <0.001 Pain 0.039 0.206 During defecation Persistent Transfusion (Yes vs No) 0.005 6.13 1.15-32.65 0.034 QoL impact (Moderate/Severe vs None/Mild) <0.001 2.92 1.25-6.82 0.013 Grade (III-IV vs I-II) <0.001 9.81 2.18-44.10 0.003 Table 4. HEMOS scoring system Variable Criteria for Scoring Assigned Points Hemorrhoids Grade Grade III-IV vs I-II 3 Prolapse Severity Frequent/Irreducible vs None/Occasional 2 Transfusion History Yes vs No 2 QoL impact Moderate/Severe vs None/Mild 1 * Total score ranges from 0 to 8 Table 5. Confusion matrix for the HEMOS score at a cut-off value of 4.0 Predicted: No Surgery Predicted: Surgery Total Actual: No Surgery 144 50 194 Actual: Surgery 2 38 40 Total 146 88 234 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7017509","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":557698930,"identity":"cb883f71-e928-4336-9da3-8b66b12fcf81","order_by":0,"name":"Yoon-Hye Kwon","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYJACZiA2AGLGBwwMFsxsYLEDxGlhBhISpGlhkwBqgYrh0WJwvPnY48I2G2OD473HKj62SbDzMTA//MBw5h5uLWeOpRvPbEszMzhzLu3mzDaQw9iMJRhuFOPWciPHTJq37bCNGZBxmxeshcGMgeFDAiEt/8Faiv+CtbB/I0bLATOQFmZGsBYeoC03cGuRPHMsTZrnXLKx/ZkzxpI954BamHmKJRLO4NbCBwwxaZ4yO8OZ7T2GH36U2STLt7dv/PDhGG4tCgeABCMbQiAZHE24NTAwyDeAyD8IATs8ikfBKBgFo2CEAgD/4k2jYj++1wAAAABJRU5ErkJggg==","orcid":"","institution":"Eulji University College of Medicine, Uijeongbu Eulji Medical Center","correspondingAuthor":true,"prefix":"","firstName":"Yoon-Hye","middleName":"","lastName":"Kwon","suffix":""}],"badges":[],"createdAt":"2025-07-01 07:53:25","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7017509/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7017509/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":98424248,"identity":"4ce3f300-51cb-456e-a94b-9f673586a576","added_by":"auto","created_at":"2025-12-17 16:33:06","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":130532,"visible":true,"origin":"","legend":"\u003cp\u003eReceiver operating characteristic (ROC) curve of the HEMOS score for predicting surgical intervention. The area under the curve (AUC) was 0.896, indicating excellent discriminative ability\u003c/p\u003e","description":"","filename":"Fig1.ROCcurve.png","url":"https://assets-eu.researchsquare.com/files/rs-7017509/v1/7e7a22fbd495339980c01f31.png"},{"id":97965547,"identity":"18909e9a-4b34-4b82-855b-40ce8f5b4a48","added_by":"auto","created_at":"2025-12-11 09:49:28","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":90096,"visible":true,"origin":"","legend":"\u003cp\u003eSurgery rates according to HEMOS score groups. The proportion of patients undergoing surgery increased progressively with higher HEMOS scores\u003c/p\u003e","description":"","filename":"Fig2.SurgeryratesbyHEMOSscoregroup.png","url":"https://assets-eu.researchsquare.com/files/rs-7017509/v1/f1d31dda110df8a8a75acd90.png"},{"id":105896080,"identity":"1365d190-3273-4756-9b3f-7653a56a025b","added_by":"auto","created_at":"2026-04-01 08:43:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1167774,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7017509/v1/9c11c283-da58-438c-af8a-cdf8c24abf3a.pdf"},{"id":97965545,"identity":"ceac99eb-ba4f-4800-8631-b7eb4091bd86","added_by":"auto","created_at":"2025-12-11 09:49:28","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":94378,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementalmaterialFiguresandTables.docx","url":"https://assets-eu.researchsquare.com/files/rs-7017509/v1/5ea27a86db81ae722bc7a09b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Development of the HEMOS (Hemorrhoid Operative Selection) Score: A Clinical Tool to Support Operative Consideration in Hemorrhoid Patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eHemorrhoidal disease is one of the most common benign anorectal conditions, with prevalence rates ranging from 4.4% to 38% depending on population demographics and diagnostic criteria [1, 2]. In South Korea, the prevalence of hemorrhoids diagnosed by physicians was 7.2% [3], with hemorrhoidectomy ranks as the third most common surgery according to the 2023 National Statistics Report by the National Health Insurance Service [4]. This substantial healthcare burden highlights the importance of establishing evidence-based criteria for surgical decision-making.\u003c/p\u003e\n\u003cp\u003ePatients with hemorrhoidal disease present with a wide spectrum of symptoms, ranging from mild discomfort to severe prolapse requiring surgical intervention. However, treatment decisions remain largely subjective and are often based solely on anatomical grading. The Goligher classification, developed over five decades ago, remains the standard staging system but focuses exclusively on prolapse severity, failing to incorporate critical clinical variables such as symptom burden, quality-of-life impact, and treatment response [5]. Several studies have reported poor correlation between anatomical grade and functional impairment [6-8].\u003c/p\u003e\n\u003cp\u003eDespite the complexity of clinical presentations, no validated scoring system currently exists that integrates anatomical, symptomatic, and patient-reported data to guide surgical decision-making. While existing clinical guidelines provide general recommendations, structured tools to support consistent and individualized decision-making remain limited [9, 10]. This gap contributes to substantial inter-clinician variability and hinders evidence-based counseling. To address these gaps, we developed a practical clinical scoring system, the \u003cu\u003eHem\u003c/u\u003eorrhoid \u003cu\u003eO\u003c/u\u003eperative \u003cu\u003eS\u003c/u\u003eelection (HEMOS) score, that systematically integrates multiple clinical variables to support individualized surgical decision-making in patients with symptomatic hemorrhoidal disease. This study aims to describe the development and validation of the HEMOS score.\u003c/p\u003e"},{"header":"Materials and method","content":"\u003cp\u003e\u003cstrong\u003eStudy Design and Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective, single-center, observational study was conducted at Uijeongbu Eulji Medical Center between January 2023 and December 2024. We systematically reviewed electronic medical records of consecutive patients presenting to the outpatient colorectal clinic with anorectal symptoms. Patients with symptomatic hemorrhoidal disease, as diagnosed by clinical examination and confirmed by a board-certified colorectal surgeon, were included in the analysis. Exclusion criteria included a history of colorectal or anal malignancy, inflammatory bowel disease (Crohn’s disease or ulcerative colitis), or previous hemorrhoidectomy performed within the preceding 3 months to minimize confounding from recent surgical intervention.\u0026nbsp;Patients with asymptomatic hemorrhoids discovered incidentally during evaluation or with incomplete clinical documentation were also excluded.\u003c/p\u003e\n\u003cp\u003eAll patients underwent standardized clinical evaluation by a single board-certified colorectal surgeon with over 10 years of experience in anorectal disease. Clinical variables were systematically collected using standardized case report forms. Primary variables included hemorrhoid grade according to Goligher's classification (Grade I-IV), prolapse severity categorized as none, occasional (with straining), frequent (with minimal straining), or irreducible, and bleeding severity assessed by patient-reported symptoms and documented anemia. Transfusion requirement was defined according to institutional protocol as the need for packed red blood cell transfusion in the context of hemorrhoid-related bleeding, typically associated with hemoglobin levels \u0026lt;7.0 g/dL. This threshold was chosen in line with restrictive transfusion strategies recommended by current guidelines. Additional variables included anal pain, bowel habits, and quality of life impact assessed using a 4-point scale (none, mild, moderate, severe). Prior hemorrhoidectomy, fecal incontinence, comorbidities, medication use, and treatment preferences\u0026nbsp;were also recorded. All variables were assessed at the baseline outpatient visit during the initial evaluation by the colorectal surgeon.\u003c/p\u003e\n\u003cp\u003eThe primary outcome was surgical intervention (hemorrhoidectomy) following initial clinical evaluation. Treatment decisions were made by a single board-certified colorectal surgeon based on comprehensive clinical assessment, including symptom severity, anatomical findings, and patient preference. All surgical procedures were performed using standardized semi-closed hemorrhoidectomy technique. We acknowledge that using surgeon's decision as the primary outcome introduces inherent bias, as the prediction model reflects individual practice patterns rather than universally objective surgical indications.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eContinuous variables were expressed as means ± standard deviations (SD), and categorical variables as frequencies and percentages. Between-group comparisons used Student’s t-test for continuous variables and the chi-square test or Fisher’s exact test for categorical variables.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMultivariable logistic regression analysis was performed using forward stepwise selection (p-entry \u0026lt;0.05, p-removal \u0026gt;0.10). Variables with p\u0026lt;0.10 in univariable analysis were included in the initial multivariable model. The HEMOS score was developed by converting regression coefficients to integer points using proportional scaling. The variable with the highest coefficient (hemorrhoid grade) was assigned 3 points, and other variables were scaled accordingly. A maximum of 3 points per variable was chosen to facilitate intuitive interpretation while preserving the relative weight of each predictor.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe model’s discriminatory performance was evaluated using the area under the receiver operating characteristic curve (AUC), and calibration was assessed using the Hosmer–Lemeshow goodness-of-fit test. The optimal cut-off score was determined using Youden's [11], which identifies the threshold that best distinguishes surgical from non-surgical cases. Internal validation was performed using 5-fold cross-validation repeated 10 times.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll statistical analyses were conducted using SPSS version 25.0 (IBM Corp., Armonk, NY) for descriptive statistics and logistic regression analysis, and Python 3.9 for ROC analysis and cross-validation. Two-sided p-values \u0026lt;0.05 were considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Institutional Review Board of Uijeongbu Eulji Medical Center (IRB number UEMC 2025-05-002). Informed consent was waived due to the retrospective nature and use of de-identified data. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eBaseline Characteristics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA total of 234 patients with symptomatic hemorrhoidal disease were included in this study. The mean age was 54.15 ± 14.34 years, and 140 (59.8%) were female. Table 1 summarizes the baseline characteristics. Hemorrhoidal bleeding was present in 138 patients (59.0%), and 10 patients (4.3%) required red blood cell transfusion for anemia, defined as hemoglobin \u0026lt;7.0 g/dL. Regarding prolapse, 36 patients (15.4%) reported no prolapse, 121 patients (51.7%) had occasional prolapse, 70 patients (30.0%) had frequent prolapse, and 7 patients (3.0%) had irreducible prolapse. Anal pain during defecation was reported by 79 patients (33.8%), and persistent pain in 9 patients (3.8%). Quality of life impairment was distributed as 12 patients (5.1%) had no impairment, 143 (61.1%) had mild impairment, 67 (28.6%) had moderate impact, and 12 (5.1%) had severe impairment. According to Goligher's classification, 36 patients (15.4%) were grade I, 67 (28.6%) grade II, 113 (48.3%) grade III, and 18 (7.7%) grade IV. Constipation was reported by 31.6% of patients, fecal incontinence by 5.6%, and 9.8% had undergone previous hemorrhoidectomy. Anticoagulation therapy was noted in 11.1% of the cohort.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTreatment Outcomes and Predictive Factors\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the 234 patients, 40 (17.1%) underwent hemorrhoidectomy while 194 (82.9%) were managed conservatively with dietary modification, warm water sitz bath, and topical agents. Univariate analysis demonstrated significant differences between the surgical and non-surgical groups in hemorrhoid grade (p\u0026lt;0.001), prolapse severity (p\u0026lt;0.001), anal pain (p=0.039), transfusion requirement (p=0.005), and quality of life impact (p\u0026lt;0.001) (Table 2). Age, sex, and use of anticoagulation were not significantly associated with surgical intervention. Although fecal incontinence and a history of previous hemorrhoidectomy were more common in the non-surgical group, these differences did not reach statistical significance.\u003c/p\u003e\n\u003cp\u003eMultivariable logistic regression analysis identified four independent predictors of surgical intervention (Table 3). Grade III-IV hemorrhoids were most strongly associated with surgery (OR 9.81, 95% CI 2.18-44.10; p=0.003), followed by transfusion-requiring bleeding (OR 6.13, 95% CI 1.15-32.65; p=0.034), frequent or irreducible prolapse (OR 5.21, 95% CI 2.12-12.81; p\u0026lt;0.001), and moderate-to-severe quality of life impact (OR 2.92, 95% CI 1.25-6.82; p=0.013). The model demonstrated good fit (Hosmer-Lemeshow test χ²=6.82, p=0.525) and accounted for 42.1% of the variance in surgical decisions (Nagelkerke R²=0.421).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDevelopment and Performance of HEMOS Score\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA clinical scoring system was developed based on the final multivariable logistic regression model (Table 4). Points were allocated to each variable in proportion to the magnitude of its regression coefficient: hemorrhoid grade III–IV was assigned 3 points, frequent or irreducible prolapse 2 points, transfusion history 2 points, and moderate-to-severe quality of life impact 1 point. The total HEMOS score thus ranged from 0 to 8, providing a simple additive tool to stratify patients according to their likelihood of requiring surgical intervention.\u003c/p\u003e\n\u003cp\u003eReceiver operating characteristic (ROC) curve analysis demonstrated excellent discriminative ability, with an area under the curve (AUC) of 0.896 (Figure 1). An optimal cut-off score of 4.0 was selected based on the maximum Youden index (0.692), with detailed sensitivity, specificity, and Youden index values across all cut-offs provided in Supplementary Table 1. At this threshold, the HEMOS score achieved a sensitivity of 95.0%, specificity of 74.2%, and an overall accuracy of 77.8% for predicting surgical intervention. The confusion matrix (Table 5, Supplementary Figure 1) showed 38 true positives, 2 false negatives, 50 false positives, and 144 true negatives.\u003c/p\u003e\n\u003cp\u003eThe HEMOS score demonstrated clear discrimination across different score ranges. Patients with scores of 0-3 exhibited low surgery rates (1.2-1.7%), whereas those with scores ≥6 had substantially higher surgery rates (57.4%), with intermediate groups showing a graduated increase (Figure 2). This distribution supports the score's potential clinical utility as a decision-support tool in routine practice.\u003c/p\u003e\n\u003cp\u003eInternal validation using five-fold cross-validation yielded a mean AUC of 0.900 (range, 0.83–0.98) and a mean accuracy of 81.5%, indicating robust performance and reproducibility of the HEMOS score. Detailed performance metrics for each fold are provided in Supplementary Table 2.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eSeveral scoring systems have been developed to assess hemorrhoidal disease, each with distinct strengths and limitations. The Golliger classification [5], while widely adopted, only assesses the extent of prolapse, without considering other important symptomatic and functional aspects such as bleeding, pain, or quality of life impact. Multiple studies have demonstrated significant interobserver variability in Goligher classification application, raising concerns about clinical reliability [6, 12]. The lack of detailed anatomical descriptions in the Goligher system hinders the expression of true disease severity and often leads to inaccurate classification [13].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eMore comprehensive systems such as the COS [14], Shanmugam score [15] and Gerjy score [16] have incorporated additional clinical variables but were primarily designed for postoperative assessment or limited to surgical cohorts. Newer classification systems including BPRST [17], Sodergren [18], PATE systems [19, 20] and PROM-HISS [21] have attempted to provide a broader symptom integration, but none has achieved universal adoption due to complexity, limited validation, or narrow applicability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe HEMOS score was developed to address a specific gap in clinical practice - the absence of a standardized and practical tool for preoperative surgical decision-making. Unlike existing systems that focus primarily on symptom assessment or postoperative outcomes, HEMOS score specifically targets the surgical decision-making process through systematic integration of multiple clinically relevant variables.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study introduces the first validated scoring system specifically designed to standardize surgical decision-making in symptomatic hemorrhoidal disease. The inclusion of quality of life impact as a weighted variable emphasizes the importance of patient-reported outcomes in surgical decision-making, aligning with contemporary patient-centered care paradigms [7, 21]. This represents a significant advancement beyond purely anatomical criteria toward functional and experiential measures of disease burden. Recent studies have consistently demonstrated that patients with high symptom burden experience significantly reduced quality of life compared to the general population, and importantly, that anatomical grading does not reflect the disease burden experienced by patients. The integration of quality of life measures into surgical decision-making algorithms represents a crucial step toward more comprehensive patient care in hemorrhoidal disease [7].\u003c/p\u003e\n\u003cp\u003eTransfusion-requiring bleeding, though affecting only 4.3% of our cohort, emerged as a strong surgical predictor (OR 6.13). This finding underscores that severe bleeding complications, while uncommon, represent important surgical indications regardless of anatomical grade. Emergency surgery for hemorrhoidal disease is rare in general practice, but is essential when severe bleeding and anemia are present. Previous studies [22, 23] have documented hemorrhoids as sources of massive bleeding requiring emergency intervention, supporting the inclusion of transfusion history as a high-weighted variable. These results confirm that even in the absence of high-grade prolapse, severe bleeding should be considered an essential component of surgical treatment. This again emphasizes the importance of incorporating clinically significant events into decision-making algorithms. The HEMOS score's practical design enables rapid application in outpatient settings using standard clinical information without additional diagnostic workup. It is a simple integer scale from 0 to 8 that can be quickly applied in clinical practice. The simple 0-8 integer scale with an optimal cutoff of 4.0 provides clinicians with an objective framework for surgical consideration while maintaining high sensitivity (95.0%) to avoid missing surgical candidates.\u003c/p\u003e\n\u003cp\u003eThis study has several important limitations that require careful consideration. The single-center, single-surgeon design introduces potential bias reflecting individual practice patterns rather than universal surgical necessity. We acknowledge this inherent limitation - the scoring system predicts surgical likelihood in this specific clinical setting rather than providing absolute criteria for surgical need. This inherent limitation reflects the fact that the model may mirror the practice patterns of a single surgeon, rather than universal surgical necessity. However, this limitation paradoxically reflects the reality that motivated this study's design. The absence of standardized, evidence-based criteria for surgical decision-making in hemorrhoidal disease is precisely what leads to significant inter-physician variability in treatment recommendations. The HEMOS score provides a structured framework for documenting and standardizing these decisions, even though it may initially reflect individual practice patterns.\u003c/p\u003e\n\u003cp\u003eThe retrospective design limits control for confounding variables, and the relatively small sample size with low surgical rate (17.1%) may affect estimate precision. Additionally, not all patients underwent laboratory confirmation of anemia, as routine testing is not standard practice for hemorrhoidal symptoms [24]. While this reflects typical clinical workflow, it may introduce misclassification bias for transfusion-related variables. Finally, there are patients who initially managed conservatively may later require surgery, and some recommended for surgery may be lost to follow-up or decline intervention. This temporal variability in treatment decisions represents an inherent limitation in hemorrhoidal disease research.\u003c/p\u003e\n\u003cp\u003eDespite these limitations, the study demonstrates notable strengths including consecutive patient recruitment, standardized assessment protocols, and rigorous statistical methodology. The scoring model balances accuracy with clinical usability, making it suitable for immediate practical application while serving as a foundation for future validation studies.\u003c/p\u003e\n\u003cp\u003eExternal validation through multicenter studies incorporating diverse patient populations and practice settings is essential to confirm the HEMOS score's generalizability. Such validation should evaluate performance across different demographic subgroups and healthcare systems to establish broader clinical utility. The score's applicability to various interventional procedures beyond traditional hemorrhoidectomy, such as rubber band ligation, Doppler-guided ligation, and stapled hemorrhoid fixation, requires further investigation.\u003c/p\u003e\n\u003cp\u003eProspective trials evaluating long-term outcomes, including symptom recurrence, patient satisfaction, and quality of life improvement, would strengthen evidence for the score's clinical utility. Cost-effectiveness analyses could further elucidate the health economic impact of implementing standardized decision-making tools in hemorrhoidal disease management.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe HEMOS score provides a practical and internally validated tool to support surgical decision-making in patients with symptomatic hemorrhoidal disease. By systematically integrating anatomical findings, symptom severity, and quality of life impact, this scoring system offers an evidence-based framework that may help reduce variability in treatment recommendations. Further multicenter studies are warranted to externally validate the HEMOS score and confirm its broader applicability across diverse clinical settings.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: No funds, grants, or other support was received\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest/Competing interests\u003c/strong\u003e: The authors declare no conflicts of interest regarding this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e: This study was approved by the\u0026nbsp;Institutional Review Board of Uijeongbu Eulji Medical Center (IRB number UEMC 2025-05-002)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e: Informed consent was waived by the board\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e: Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analysed during the current study available from the corresponding author on reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e: Yoon-Hye Kwon designed the study, analyzed the data and wrote the manuscript\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRiss S, Weiser FA, Schwameis K, Riss T, Mittlbock M, Steiner G, Stift A (2012) The prevalence of hemorrhoids in adults. 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Present and prospects of hemorrhoidal classification. Front Med (Lausanne) 10\u003cstrong\u003e:\u003c/strong\u003e1252468\u003c/li\u003e\n\u003cli\u003evan Tol RR, Kimman ML, Melenhorst J, Stassen LPS, Dirksen CD, Breukink SO, Members of the Steering G (2019) European Society of Coloproctology Core Outcome Set for haemorrhoidal disease: an international Delphi study among healthcare professionals. Colorectal Dis 21\u003cstrong\u003e:\u003c/strong\u003e570-580\u003c/li\u003e\n\u003cli\u003eShanmugam V, Watson AJ, Chapman AD, Binnie NR, Loudon MA (2005) Pathological audit of stapled haemorhoidopexy. Colorectal Dis 7\u003cstrong\u003e:\u003c/strong\u003e172-175\u003c/li\u003e\n\u003cli\u003eGerjy R, Derwinger K, Lindhoff-Larson A, Nystrom PO (2012) Long-term results of stapled haemorrhoidopexy in a prospective single centre study of 153 patients with 1-6 years\u0026apos; follow-up. Colorectal Dis 14\u003cstrong\u003e:\u003c/strong\u003e490-496\u003c/li\u003e\n\u003cli\u003eSobrado CW, de Almeida Obregon C, Sobrado LF, Bassi LM, Bacchi Hora JA, Silva ESJAH, Nahas SC, Cecconello I (2021) The novel BPRST classification for hemorrhoidal disease: A cohort study and an algorithm for treatment. Ann Med Surg (Lond) 61\u003cstrong\u003e:\u003c/strong\u003e97-100\u003c/li\u003e\n\u003cli\u003eSha HL, Roslani AC, Poh KS (2020) Evaluating the ability of the Sodergren score to guide the management of internal haemorrhoidal disease. Colorectal Dis 22\u003cstrong\u003e:\u003c/strong\u003e1379-1387\u003c/li\u003e\n\u003cli\u003eGaj F, Trecca A (2004) [PATE 2000 Sorrento: a modern, effective instrument for defining haemorrhoids. A multicentre observational study conducted in 930 symptomatic patients]. Chir Ital 56\u003cstrong\u003e:\u003c/strong\u003e509-515\u003c/li\u003e\n\u003cli\u003eGaj F, Trecca A (2007) [New \u0026quot;PATE 2006\u0026quot; system for classifying hemorrhoidal disease: advantages resulting from revision of \u0026quot;PATE 2000 Sorrento\u0026quot;]. Chir Ital 59\u003cstrong\u003e:\u003c/strong\u003e521-526\u003c/li\u003e\n\u003cli\u003eKuiper SZ, Kimman ML, Van Tol RR, Waardenburg SF, Van Kuijk SMJ, Dirksen CD, Breukink SO (2022) Patient reported outcome measure-haemorrhoidal impact and satisfaction score (PROM-HISS): Development, reliability and construct validity. Colorectal Dis 24\u003cstrong\u003e:\u003c/strong\u003e992-999\u003c/li\u003e\n\u003cli\u003eKrebs ED, Zhang AY, Hassinger TE, Suraju MO, Berry PS, Hoang SC, Hedrick TL, Friel CM (2020) Preoperative bleeding requiring transfusion: An under-reported indication for hemorrhoidectomy. Am J Surg 220\u003cstrong\u003e:\u003c/strong\u003e428-431\u003c/li\u003e\n\u003cli\u003eDeng H, Fang X, Wang H, Li M (2024) Preoperative Blood Transfusion Requirements for Hemorrhoidal Severe Anemia: A Retrospective Study of 128 Patients. Med Sci Monit 30\u003cstrong\u003e:\u003c/strong\u003ee943126\u003c/li\u003e\n\u003cli\u003eFathallah N, Beaussier H, Chatellier G, Meyer J, Sapoval M, Moussa N, de Parades V (2021) Proposal for a New Score: Hemorrhoidal Bleeding Score. Ann Coloproctol 37\u003cstrong\u003e:\u003c/strong\u003e311-317\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eBaseline characteristics of patients with symptomatic hemorrhoidal disease\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"519\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eClinical characteristics\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(n=234)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge, years, mean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e54.15 \u0026plusmn; 14.34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Female\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e140 (59.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e94 (40.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnticoagulation, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e26 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBleeding, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e138 (59.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProlapse, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;None/Occasional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e157 (67.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Frequent/Irreducible\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e77 (32.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePain, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;During defecation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e79 (33.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Persistent\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e9 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransfusion, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e10 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQoL impact, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;None/Mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e155 (66.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Moderate/Severe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e79 (33.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eConstipation, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e74 (31.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFecal incontinence, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e13 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious hemorrhoidectomy, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e23 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrade, n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; I\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e36 (15.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e67 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; III\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e113 (48.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 226px;\"\u003e\n \u003cp\u003e\u0026nbsp; IV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 294px;\"\u003e\n \u003cp\u003e18 (7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eUnivariate analysis of clinical factors associated with surgical intervention\u003c/p\u003e\n\u003ctable style=\"border: none;width:446.05pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border:solid windowtext 1.0pt;background: #D9D9D9;padding:0cm 4.95pt 0cm 4.95pt;height:17.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:solid windowtext 1.0pt;border-left: none;background:#D9D9D9;padding:0cm 4.95pt 0cm 4.95pt;height:17.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eNon-surgical group (n=194)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:solid windowtext 1.0pt;border-left: none;background:#D9D9D9;padding:0cm 4.95pt 0cm 4.95pt;height:17.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp;Surgical group\u0026nbsp;\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e(n=40)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:solid windowtext 1.0pt;border-left: none;background:#D9D9D9;padding:0cm 4.95pt 0cm 4.95pt;height:17.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003ep-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eAge, years, mean \u0026plusmn; SD\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e53.91 \u0026plusmn; 14.48\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e55.35 \u0026plusmn; 13.73\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e0.563\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eGender, n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e0.705\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid 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4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Male\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e79 (40.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e15 (37.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:justify;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family: \"Times New Roman\",serif;color:black;'\u003eAnticoagulation, n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e22 (11.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e4 (10.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e0.806\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eBleeding, n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e109 (56.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e29 (72.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e0.056\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eProlapse, n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;None/Occasional\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e146 (75.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e10 (25.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Frequent/Irreducible\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e48 (24.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e30 (75.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003ePain, n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:red;'\u003e0.039\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;During defecation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e63 (32.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e16 (40.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Persistent\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e5 (2.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e4 (10.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:justify;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family: \"Times New Roman\",serif;color:black;'\u003eTransfusion, n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e5 (2.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e5 (12.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:red;'\u003e0.005\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:justify;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family: \"Times New Roman\",serif;color:black;'\u003eQoL impact, n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;None/Mild\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e143 (73.7)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e12 (30.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Moderate/Severe\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e51 (26.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e28 (70.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:justify;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family: \"Times New Roman\",serif;color:black;'\u003eConstipation, n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e65 (33.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e9 (22.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e0.173\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:justify;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family: \"Times New Roman\",serif;color:black;'\u003eFecal incontinence, n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e12 (6.2)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e1 (2.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e0.354\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:25.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003ePrevious hemorrhoidectomy, n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:25.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e21 (10.8)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:25.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e2 (5.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:25.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e0.260\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eGrade, n (%)\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp; I\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e36 (18.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e0 (0.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp; II\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e65 (33.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e2 (5.0)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp; III\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e84 (43.3)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e29 (72.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:169.6pt;border:solid windowtext 1.0pt;border-top: none;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp; IV\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:106.35pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e9 (4.6)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:4.0cm;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding: 0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e9 (22.5)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:2.0cm;border-top:none;border-left:none;border-bottom: solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding: 0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eMultivariable logistic regression analysis of factors associated with surgical intervention\u003c/p\u003e\n\u003ctable style=\"border: none;width:450.0pt;border-collapse:collapse;\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width:173.8pt;border:solid windowtext 1.0pt;border-bottom:solid black 1.0pt;background:#D9D9D9;padding:0cm 4.95pt 0cm 4.95pt;height:17.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width:55.45pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid black 1.0pt;border-right:solid windowtext 1.0pt;background:#D9D9D9;padding:0cm 4.95pt 0cm 4.95pt;height:17.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eUnivariate\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" style=\"width:220.75pt;border-top:solid windowtext 1.0pt;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid black 1.0pt;background:#D9D9D9;padding:0cm 4.95pt 0cm 4.95pt;height:17.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eMultivariable\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:54.95pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#D9D9D9;padding:0cm 4.95pt 0cm 4.95pt;height:17.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eOR\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:110.85pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#D9D9D9;padding:0cm 4.95pt 0cm 4.95pt;height:17.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e95% CI\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;background:#D9D9D9;padding:0cm 4.95pt 0cm 4.95pt;height:17.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eP-value\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:173.8pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eBleeding\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:55.45pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e0.056\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:110.85pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e0.149\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:173.8pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:38.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eProlapse\u003cbr\u003e\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-family: \"Times New Roman\",serif;color:black;'\u003e(Frequent/Irreducible vs 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style=\"width:110.85pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:38.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:8.0pt;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;'\u003e\u003cspan style='font-family: \"Times New Roman\",serif;color:black;'\u003e2.12-12.81\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:38.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:red;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:173.8pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003ePain\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:55.45pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e0.039\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:110.85pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;'\u003e0.206\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:173.8pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;text-indent:10.0pt;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eDuring defecation\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:55.45pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:110.85pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:173.8pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp;Persistent\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:55.45pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:110.85pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:16.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\";color:black;'\u003e \u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:173.8pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:25.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:justify;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family: \"Times New Roman\",serif;color:black;'\u003eTransfusion\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u003cbr\u003e\u0026nbsp;(Yes vs No)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:55.45pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:25.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e0.005\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:25.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e6.13\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:110.85pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:25.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e1.15-32.65\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:25.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:red;'\u003e0.034\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:173.8pt;border-top:none;border-left:solid windowtext 1.0pt;border-bottom:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:25.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:justify;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family: \"Times New Roman\",serif;color:black;'\u003eQoL impact\u003cbr\u003e\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-family: \"Times New Roman\",serif;color:black;'\u003e(Moderate/Severe vs None/Mild)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:55.45pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:25.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:25.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e2.92\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:110.85pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:25.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e1.25-6.82\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border:none;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:25.5pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:red;'\u003e0.013\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width:173.8pt;border:solid windowtext 1.0pt;border-top: none;padding:0cm 4.95pt 0cm 4.95pt;height:26.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:left;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003eGrade\u003cbr\u003e\u003c/span\u003e\u003c/strong\u003e\u003cspan style='font-family: \"Times New Roman\",serif;color:black;'\u003e(III-IV vs I-II)\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:55.45pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:26.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e\u0026lt;0.001\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:26.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e9.81\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:110.85pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:26.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:black;'\u003e2.18-44.10\u003c/span\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width:54.95pt;border-top:none;border-left:none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;padding:0cm 4.95pt 0cm 4.95pt;height:26.25pt;\"\u003e\n \u003cp style='margin-top:0cm;margin-right:0cm;margin-bottom:0cm;margin-left:0cm;text-align:center;font-size:13px;font-family:\"Malgun Gothic\",sans-serif;line-height:normal;'\u003e\u003cstrong\u003e\u003cspan style='font-family:\"Times New Roman\",serif;color:red;'\u003e0.003\u003c/span\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eHEMOS scoring system\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"570\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCriteria for Scoring\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssigned Points\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHemorrhoids Grade\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp\u003eGrade III-IV vs I-II\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProlapse Severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp\u003eFrequent/Irreducible vs None/Occasional\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTransfusion History\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp\u003eYes vs No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 148px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eQoL impact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 246px;\"\u003e\n \u003cp\u003eModerate/Severe vs None/Mild\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 177px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*\u0026nbsp;Total score ranges from 0 to 8\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u0026nbsp;\u003c/strong\u003eConfusion matrix for the HEMOS score at a cut-off value of 4.0\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"563\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e \u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePredicted: No Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePredicted: Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActual: No Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e194\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eActual: Surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 155px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 137px;\"\u003e\n \u003cp\u003e88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 136px;\"\u003e\n \u003cp\u003e234\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hemorrhoids, Scoring System, Treatment Decision-Making, Surgical Intervention, Quality of Life, Prediction Model","lastPublishedDoi":"10.21203/rs.3.rs-7017509/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7017509/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003e\u003c/em\u003eTo develop and validate the Hemorrhoid Operative Selection (HEMOS) score, a practical clinical scoring system that integrates anatomical findings, symptom severity, and quality of life impact to support evidence-based surgical decision-making in patients with symptomatic hemorrhoidal disease.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/em\u003e This retrospective, single-center study included 234 patients with symptomatic hemorrhoids treated at Uijeongbu Eulji Medical Center between January 2023 and December 2024. Clinical variables assessed were hemorrhoid grade, prolapse severity, bleeding, transfusion requirement, pain, and quality of life impact. The primary outcome was surgical intervention. Multivariable logistic regression identified independent predictors of surgery, which were used to construct the HEMOS score. Model performance was evaluated using receiver operating characteristic (ROC) curve analysis.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/em\u003e Forty patients (17.1%) underwent surgery. Four independent predictors were identified: grade III–IV hemorrhoids, frequent or irreducible prolapse, transfusion-requiring bleeding, and moderate-to-severe quality of life impact. The HEMOS score (range 0–8) demonstrated excellent discrimination (AUC 0.896), with a cut-off of ≥4 yielding 95.0% sensitivity and 74.2% specificity for predicting surgical intervention.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e\u003c/em\u003e The HEMOS score provides a practical, internally validated tool that systematically integrates key clinical variables to support surgical decision-making in hemorrhoidal disease. Further multicenter studies are warranted to externally validate its performance and confirm broader applicability.\u003c/p\u003e","manuscriptTitle":"Development of the HEMOS (Hemorrhoid Operative Selection) Score: A Clinical Tool to Support Operative Consideration in Hemorrhoid Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-11 09:49:23","doi":"10.21203/rs.3.rs-7017509/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"10935abc-480a-4aa8-8a99-ac174d04f207","owner":[],"postedDate":"December 11th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-04-01T08:42:00+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-11 09:49:23","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7017509","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7017509","identity":"rs-7017509","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}