title: Utilization and safety of sodium hyaluronate-carboxymethylcellulose adhesion barrier.
abstract: BACKGROUND
  Little is known about the use and toxicity of antiadhesion substances such as sodium hyaluronate-carboxymethylcellulose.
  
  
  OBJECTIVE
  We analyzed the patterns of use and safety of sodium hyaluronate-carboxymethylcellulose in patients undergoing colectomy and gynecologic surgery.
  
  
  METHODS
  This is a retrospective cohort study.
  
  
  METHODS
  This study covered hospitals nationwide.
  
  
  METHODS
  All patients in the Premier Perspective database who underwent colectomy or hysterectomy from 2000 to 2010 were included in the analyses.
  
  
  METHODS
  Hyaluronate-carboxymethylcellulose use was determined by billing codes. For the primary outcome, we used hierarchical mixed-effects logistic regression models to determine the factors associated with the use of hyaluronate-carboxymethylcellulose, whereas a propensity score-matched analysis was used to secondarily assess the association between hyaluronate-carboxymethylcellulose use and toxicity (abscess, bowel and wound complications, peritonitis).
  
  
  RESULTS
  We identified 382,355 patients who underwent hysterectomy and 267,368 who underwent colectomy. For hysterectomy, hyaluronate-carboxymethylcellulose use was 5.0% overall, increasing from 1.1% in 2000 to 9.8% in 2010. Hyaluronate-carboxymethylcellulose was used in 8.1% of those who underwent colectomy and increased from 6.2% in 2000 to 12.4% in 2010. The year of diagnosis and procedure volume of the attending surgeon were the strongest predictors of hyaluronate-carboxymethylcellulose use. After matching and risk adjustment, hyaluronate-carboxymethylcellulose use was not associated with abscess formation (1.5% vs 1.5%) (relative risk = 0.97; 95% CI, 0.84-1.12) in those who underwent hysterectomy. A patient receiving hyaluronate-carboxymethylcellulose had a 13% increased risk of abscess (17.4% vs 15.0%) (relative risk = 1.13; 95% CI, 1.08-1.17) after colectomy.
  
  
  CONCLUSIONS
  This was an observational study.
  
  
  CONCLUSIONS
  Hyaluronate-carboxymethylcellulose use has increased over the past decade for colectomy and hysterectomy. Although there is no association between hyaluronate-carboxymethylcellulose use and abscess following hysterectomy, hyaluronate-carboxymethylcellulose use was associated with a small increased risk of abscess after colectomy.
authors.affiliation: 1 Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, New York, New York 2 Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York 3 Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York 4 Herbert Irving Comprehensive Cancer Center, New York, New York.
authors.forename: Shazia
authors.initials: S
authors.lastname: Bashir
authors.forename: Cande V
authors.initials: CV
authors.lastname: Ananth
authors.forename: Sharyn N
authors.initials: SN
authors.lastname: Lewin
authors.forename: William M
authors.initials: WM
authors.lastname: Burke
authors.forename: Yu-Shiang
authors.initials: YS
authors.lastname: Lu
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
authors.forename: Dawn L
authors.initials: DL
authors.lastname: Hershman
authors.forename: Jason D
authors.initials: JD
authors.lastname: Wright
mesh_terms: D001672:Biocompatible Materials / Q000009:adverse effects / Q000627:therapeutic use*; D002266:Carboxymethylcellulose Sodium / Q000009:adverse effects / Q000627:therapeutic use*; D003082:Colectomy / Q000009:adverse effects; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D006820:Hyaluronic Acid / Q000009:adverse effects / Q000627:therapeutic use*; D007044:Hysterectomy / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D057216:Propensity Score; D012189:Retrospective Studies; D013997:Time Factors; D000267:Tissue Adhesions / Q000209:etiology / Q000517:prevention & control
chemical_list: D001672:Biocompatible Materials; D008567:Membranes, Artificial; D006820:Hyaluronic Acid; D002266:Carboxymethylcellulose Sodium
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