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.
Dis Colon Rectum. 2013 Oct;56(10):1174-84. doi: 10.1097/DCR.0b013e31829ec889.
Little is known about the use and toxicity of antiadhesion substances such as sodium hyaluronate-carboxymethylcellulose.
We analyzed the patterns of use and safety of sodium hyaluronate-carboxymethylcellulose in patients undergoing colectomy and gynecologic surgery.
This is a retrospective cohort study.
This study covered hospitals nationwide.
All patients in the Premier Perspective database who underwent colectomy or hysterectomy from 2000 to 2010 were included in the analyses.
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).
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.
This was an observational study.
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.
人们对透明质酸钠-羧甲基纤维素等防粘连物质的使用和毒性知之甚少。
我们分析了透明质酸钠-羧甲基纤维素在结肠切除术和妇科手术患者中的使用模式和安全性。
这是一项回顾性队列研究。
本研究涵盖全国各医院。
2000 年至 2010 年期间在 Premier Perspective 数据库中接受结肠切除术或子宫切除术的所有患者均纳入分析。
透明质酸钠-羧甲基纤维素的使用通过计费代码确定。对于主要结局，我们使用分层混合效应逻辑回归模型来确定与透明质酸钠-羧甲基纤维素使用相关的因素，而倾向评分匹配分析用于二次评估透明质酸钠-羧甲基纤维素使用与毒性（脓肿、肠和伤口并发症、腹膜炎）之间的关联。
我们确定了 382355 例接受子宫切除术和 267368 例接受结肠切除术的患者。对于子宫切除术，透明质酸钠-羧甲基纤维素的总体使用率为 5.0%，从 2000 年的 1.1%上升到 2010 年的 9.8%。8.1%接受结肠切除术的患者使用了透明质酸钠-羧甲基纤维素，从 2000 年的 6.2%上升到 2010 年的 12.4%。手术医生的诊断年份和手术量是透明质酸钠-羧甲基纤维素使用的最强预测因素。经过匹配和风险调整后，透明质酸钠-羧甲基纤维素的使用与脓肿形成无关（子宫切除术患者中为 1.5%比 1.5%）（相对风险=0.97；95%CI，0.84-1.12）。接受透明质酸钠-羧甲基纤维素治疗的患者脓肿的风险增加了 13%（17.4%比 15.0%）（相对风险=1.13；95%CI，1.08-1.17）。
这是一项观察性研究。
在过去十年中，结肠切除术和子宫切除术使用透明质酸钠-羧甲基纤维素的情况有所增加。尽管透明质酸钠-羧甲基纤维素的使用与子宫切除术后脓肿无关，但它与结肠切除术后脓肿的小风险增加有关。
