Adhesion Barrier Use After Myomectomy and Hysterectomy: Rates and Immediate Postoperative Complications
Togas Tulandi1, Francois Closon, Nicolas Czuzoj-Shulman
1Department of Obstetrics and Gynecology, McGill University, and the Department of Epidemiology and Biostatistics, Jewish General Hospital, Montreal, Quebec, Canada.
Objective:
To evaluate use rates and immediate postoperative complications of the use of an adhesion barrier in myomectomy or hysterectomy.
Methods:
This was a retrospective cohort study. Using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample, we examined the records of women with primary discharge diagnosis of uterine myoma during the period 2003-2011. We evaluated use rates and complications among 473,788 women treated by myomectomy or hysterectomy.
Results:
Of 473,788 women treated by myomectomy or hysterectomy, adhesion barrier was used in 3,392 of 62,563 myomectomies (5.4%) and 5,590 of 411,225 hysterectomies (1.4%). The rate of ileus after myomectomy in the nonbarrier group (1,290/59,171 [2%]) was lower than in the barrier group (109/3,392 [3%]; adjusted odds ratio [OR] 1.50 [1.22-1.83]) and similar after hysterectomy (10,329/405,635 [2.5%] compared with 288/5,590 [5%]; adjusted OR 1.97 [1.75-2.23]). Postoperative fever was also higher in the adhesion barrier group after myomectomy (4.4% compared with 2.9%, adjusted OR 1.44 [1.21-1.71]) as well as after hysterectomy (2.5% compared with 1.6%, OR 1.65 [1.40-1.96]). Small bowel obstruction after hysterectomy in the nonbarrier group (804/405,635 [0.2%]) was less frequent than in the barrier group (23/5,590 [0.4%]; OR 1.90 [1.25-2.89]), but not after myomectomy.
Conclusion:
Although the use of adhesion barrier remains very low, the use is associated with a slightly higher incidence of fever and ileus after myomectomy and hysterectomy and with bowel obstruction after hysterectomy.
