Utilization and safety of sodium hyaluronate- Carboxymethylcellulose adhesion barrier

Background: Little is known about the use and toxicity of antiadhesion substances such as sodium hyaluronatecarboxymethylcellulose. Objective: We analyzed the patterns of use and safety of sodium hyaluronate- carboxymethylcellulose in patients undergoing colectomy and gynecologic surgery. DESIGN: This is a retrospective cohort study. SETTING: This study covered hospitals nationwide. PATIENTS: All patients in the Premier Perspective database who underwent colectomy or hysterectomy from 2000 to 2010 were included in the analyses. MAIN OUTCOME MEASURE: Hyaluronatecarboxymethylcellulose 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 hyaluronatecarboxymethylcellulose, whereas a propensity scorematched 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 hyaluronatecarboxymethylcellulose 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. LIMITATIONS: This was an observational study. CONCLUSION: 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, hyaluronatecarboxymethylcellulose use was associated with a small increased risk of abscess after colectomy.