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

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.