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Utilization and Safety of Sodium Hyaluronate-Carboxymethylcellulose Adhesion Barrier

Bashir, Shazia M.D.1; Ananth, Cande V. Ph.D.1; Lewin, Sharyn N. M.D.1,3; Burke, William M. M.D.1; Lu, Yu-Shiang M.S.1; Neugut, Alfred I. M.D., Ph.D.2,3,4; Herzog, Thomas J. M.D.1,4; Hershman, Dawn L. M.D.2,3,4; Wright, Jason D. M.D.1,4

doi: 10.1097/DCR.0b013e31829ec889
Original Contributions: Benign Colorectal Disease

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.

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: 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.

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, hyaluronate-carboxymethylcellulose use was associated with a small increased risk of abscess after colectomy.

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

Financial Disclosures: None reported.

Correspondence: Jason D. Wright, M.D., Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Ave, 8th Floor, New York, NY 10032. E-mail:

© 2013 The American Society of Colon and Rectal Surgeons