title: Clinical and economic impact of adhesiolysis during repeat cesarean delivery.
abstract: OBJECTIVE
  To estimate adhesiolysis rates at cesarean delivery (CD) and to estimate costs and clinical implications of performing adhesiolysis at repeat CD.
  
  
  METHODS
  Retrospective cohort using secondary data.
  
  
  METHODS
  Over 500 acute care hospitals in the USA.
  
  
  METHODS
  Women ≥15 years old with a medical claim for CD between 1 January 2007 and 31 December 2008 who were treated in a hospital that contributed data to the Premier Perspective™ database.
  
  
  METHODS
  Using data from hospital discharge records, rates of adhesiolysis at the time of CD were calculated. Among patients with repeat CD, a propensity score was used to create matched cohorts with and without adhesiolysis. Unadjusted rates and means were compared between these cohorts.
  
  
  METHODS
  Cost, length of stay and selected clinical complications between repeat CD patients with and without adhesiolysis.
  
  
  RESULTS
  Adhesiolysis was performed in 0.5% of primary and 6.1% of repeat CD patients. Using propensity scores, 10 261 women who experienced repeat CD with adhesiolysis were matched to 10 261 control women. Hospital cost ($5739 vs. $5448), length of stay (2.97 vs. 2.88 days) and operative time (84.0 vs. 74.2 min) were significantly greater in the adhesiolysis than in the non-adhesiolysis group (p < 0.01 for all comparisons), as was the overall complication rate (6.3 vs. 3.5%).
  
  
  CONCLUSIONS
  Adhesiolysis rates were higher in repeat compared with primary CD. Among repeat CD patients, costs and complications were higher in the adhesiolysis group. Reducing adhesion formation after primary CD could reduce cost and complications at the time of repeat CD.
authors.affiliation: Ethicon Inc., Somerville, NJ 08876-0151, USA.
authors.forename: Vanja
authors.initials: V
authors.lastname: Sikirica
authors.forename: Michael S
authors.initials: MS
authors.lastname: Broder
authors.forename: Eunice
authors.initials: E
authors.lastname: Chang
authors.forename: Piet
authors.initials: P
authors.lastname: Hinoul
authors.forename: David
authors.initials: D
authors.lastname: Robinson
authors.forename: Malcolm
authors.initials: M
authors.lastname: Wilson
mesh_terms: D000328:Adult; D001803:Blood Transfusion / Q000191:economics / Q000706:statistics & numerical data; D016022:Case-Control Studies; D017604:Cesarean Section, Repeat / Q000191:economics*; D015331:Cohort Studies; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007044:Hysterectomy / Q000191:economics / Q000706:statistics & numerical data; D007902:Length of Stay / Q000191:economics; D015999:Multivariate Analysis; D006473:Postpartum Hemorrhage / Q000191:economics / Q000453:epidemiology; D011247:Pregnancy; D057216:Propensity Score; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology; D000267:Tissue Adhesions / Q000150:complications* / Q000191:economics*; D014481:United States / Q000453:epidemiology