Tuesday, December 31, 2013
Saturday, December 28, 2013
Thursday, December 26, 2013
Adhesion Related Disorder International Human Rights Team IHRT: Teenager speaks out over medical condition that leaves her looking nine months pregnant every time she eats
Adhesion Related Disorder International Human Rights Team IHRT: Teenager speaks out over medical condition that leaves her looking nine months pregnant every time she eats
Sunday, December 22, 2013
BMC Surg. 2011; 11: 13.
Published online 2011 June 9. doi: 10.1186/1471-2482-11-13
The inpatient burden of abdominal and gynecological adhesiolysis in the US
Adhesions are fibrous bands of scar tissue, often a result of surgery, that form between internal organs and tissues, joining them together abnormally. Postoperative adhesions frequently occur following abdominal surgery, and are associated with a large economic burden. This study examines the inpatient burden of adhesiolysis in the United States (i.e., number and rate of events, cost, length of stay [LOS]).
Hospital discharge data for patients with primary and secondary adhesiolysis were analyzed using the 2005 Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. Procedures were aggregated by body system.
We identified 351,777 adhesiolysis-related hospitalizations: 23.2% for primary and 76.8% for secondary adhesiolysis. The average LOS was 7.8 days for primary adhesiolysis. We found that 967,332 days of care were attributed to adhesiolysis-related procedures, with inpatient expenditures totaling $2.3 billion ($1.4 billion for primary adhesiolysis; $926 million for secondary adhesiolysis). Hospitalizations for adhesiolysis increased steadily by age and were higher for women. Of secondary adhesiolysis procedures, 46.3% involved the female reproductive tract, resulting in 57,005 additional days of care and $220 million in attributable costs.
Adhesiolysis remain an important surgical problem in the United States. Hospitalization for this condition leads to high direct surgical costs, which should be of interest to providers and payers.
Keywords: Adhesions, adhesiolysis, abdominal, gynecological, burden of illness, hospitalizations
Adhesions are fibrous bands of scar tissue, often result of surgery, that form between internal organs and tissues, joining them together abnormally . Postoperative adhesions frequently occur following abdominal surgery and are a leading cause of intestinal obstruction. It has been estimated that more than 90% of patients who undergo abdominal operations will develop postoperative adhesions .
The most severe complication of postoperative adhesions is small bowel obstruction (SBO), which has a 10% risk of mortality [3,4]. Recent research has demonstrated that readmission episodes averaged 2.7 per patient for SBO or nonspecific abdominal pain (when adhesions were considered likely). Inpatient readmissions accounted for 87% of episodes; 47% of those required repeat surgery . Additionally, in the large retrospective study Surgical and Clinical Adhesions Research, surgical procedures performed on the bowel or the female reproductive system were associated with an increased chance of adhesion development, termed adhesiolysis [6-8]. Ray and colleagues found that 47% of adhesiolysis-related inpatient hospitalizations were for procedures involving the female reproductive tract . Postoperative adhesiolysis-related SBO occurred in 2.8% of patients undergoing hysterectomy for benign conditions and in 5% of those undergoing radical hysterectomy [4,9].
A number of studies have shown that the economic burden of adhesiolysis is significant [2,5,10]. It was estimated that adhesiolysis procedures resulted in 303,836 hospitalizations, 846,415 days of inpatient care, and nearly $1.3 billion in health care expenditures in the United States (US) in 1994 . This cost has decreased when compared with similar data from 1988, due in part to laparoscopic surgery. Despite the decrease in costs associated with laparoscopic surgery, increased use of such techniques did not lead to a decreased rate of overall hospitalizations .
Utilizing more recent data, we estimated the current burden of inpatient treatment of adhesiolysis in the US. This study examined the number and rate of adhesiolysis-related hospitalizations, days of care attributable to adhesiolysis, and length of stay (LOS) for adhesiolysis-related hospitalizations, with primary and secondary procedures considered separately. Additionally, we assessed total inpatient costs attributable to adhesiolysis.
Data were taken from the 2005 Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample (NIS). The NIS is the largest all-payer inpatient care database in the US and contains data from approximately 8 million hospital stays in 2005. The database also contains clinical and resource use information, including patient demographics, International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnosis and procedure codes, diagnosis-related group (DRG) codes, LOS, charges, discharge status, payer source, and hospital-specific characteristics. Using the survey design elements provided with the NIS, data can be weighted to produce nationally representative estimates . All financial information in the NIS database is presented as charges rather than costs. To convert hospital charges to costs, facility-specific cost-to-charge ratios were used. Finally, the medical care component of the Consumer Price Index was applied to inflate all financial data to 2007 US dollars .
RTI International's Institutional Review Board determined that this study met all criteria for exemption.
From the NIS, all hospitalizations containing a DRG code of peritoneal adhesiolysis with or without complications (i.e., DRG 150, 151) were defined as primary adhesiolysis-related hospitalizations. Hospitalizations containing a primary or nonprimary ICD-9-CM procedure code for adhesiolysis, but without DRG 150 or 151, were defined as secondary adhesiolysis-related hospitalizations (Table (Table1).1). Hospitalizations related to secondary adhesiolysis were stratified by body system, using the following DRG coding:
Description of Procedure (ICD-9-CM) Codes Used to Identify Adhesiolysis-Related Surgical Procedures
(1) Digestive system (i.e., DRG 148, 149, 154, or 468),
(2) Hepatobiliary system (i.e., DRG 197, 493, or 494),
(3) Female reproductive system (i.e., DRG 358, 359, 361, or 365),
(4) Pregnancy with evidence of Cesarean section (i.e., DRG 370, 371, or 378).
Study measures included the number of inpatient hospitalizations involving adhesiolysis, adhesiolysis-related hospitalization rates, days of care, and costs attributable to adhesiolysis.
Hospitalization rates per 100,000 persons were assessed using the US Census Bureau's 2005 total US civilian population projection. The total days of care attributable to adhesiolysis were estimated using methods presented by Ray and colleagues that then were adapted for the HCUP NIS . When DRG 150 or 151 (i.e., primary adhesiolysis) was the primary reason for admission, the attributed LOS was simply the mean LOS for this group. For records without a DRG of 150 or 151, excess days attributed to adhesiolysis were calculated as the difference between the mean LOS for those same procedures with adhesiolysis and those procedures without adhesiolysis within each DRG. The total number of adhesiolysis-related days then was estimated as the product of the attributed LOS for the group and the number of adhesiolysis-related hospitalizations within the group.
This study utilized the methodology from Ray and colleagues to estimate the per-day cost attributable to adhesiolysis . Cost per day was estimated by dividing the total cost of adhesiolysis-related hospitalizations divided by the total number of adhesiolysis-related inpatient days. The total inpatient expenditures attributable to adhesiolysis were estimated by multiplying the estimated cost per day attributable to adhesiolysis by the number of days attributed to adhesiolysis.
Average expenditures for surgeon's services were estimated using the Resource-Based Relative Value Scale (RBRVS). The RBRVS value was estimated for Current Procedural Terminology codes related to adhesiolysis (Table (Table2)2) and then multiplied by a fixed conversion factor to determine the average surgeon expenditures for each specific procedure. These figures then were inflated to 2007 dollars using the medical care component of the Consumer Price Index.
Description of Procedure (CPT) Codes Used to Identify Adhesiolysis-Related Surgical Procedures to Estimate Expenditures for Surgeons' Servicesa
Total inpatient costs attributable to adhesiolysis consisted of inpatient costs and costs for the surgeon's services. Estimates were made separately for primary and secondary adhesiolysis. These also were examined by body system and then aggregated to estimate a total cost. Additionally, inpatient expenditures were summarized to compare Cesarean section deliveries with and without adhesiolysis.
Results and Discussion
Table Table33 illustrates that there were 351,777 adhesiolysis-related hospitalizations in the US in 2005, representing 119 adhesiolysis hospitalizations per 100,000 persons. There were 898 adhesiolysis hospitalizations per 100,000 hospitalizations and 3,549 per 100,000 surgical hospitalizations of any kind (3.5%). Primary adhesiolysis (i.e., DRG 150 or 151) was found in 23.2% of these hospitalizations, while the remaining 76.8% were classified as secondary adhesiolysis (i.e., evidence of the procedure but with a DRG other than 150 or 151).
Rate of Adhesiolysis-Related Hospitalizations
Table Table44 presents background characteristics for the study sample. For primary adhesiolysis, the number of hospitalizations increased steadily by age; for secondary adhesiolysis, the number increased for most age categories. The lowest rate was in patients who were younger than 25 years (5.2 per 100,000 persons for primary adhesiolysis; 13.8 per 100,000 persons for secondary adhesiolysis), and the highest rate was in patients who were older than 65 years (88.4 per 100,000 persons for primary adhesiolysis; 176.7 per 100,000 persons for secondary adhesiolysis). Women had a higher hospitalization rate than men (34.9 vs. 19.7 per 100,000 persons for primary adhesiolysis; 153.1 vs. 13.4 per 100,000 persons for secondary adhesiolysis). Among primary adhesiolysis hospitalizations, almost half (48%) of the patients were admitted via the emergency department, whereas only 20.5% of the secondary adhesiolysis hospitalizations were via the emergency department. Primary adhesiolysis-related hospitalizations were evenly distributed between private insurance and governmental coverage, i.e., Medicaid and Medicare (44% and 48%, respectively), whereas more than half (56%) of the patients with secondary adhesiolysis hospitalizations had private insurance and 37.4% had government-sponsored health care coverage.
Demographics and Other Patient- and Facility-Specific Characteristics of Interest Among Adhesiolysis-Related Hospitalizations (i.e., DRG 150 or 151) in the US in 2005
A total of 967,332 inpatient days of care were attributed to primary and secondary adhesiolysis (Table (Table5).5). There were 81,532 hospitalizations and an average LOS of 7.8 days per stay, totaling 632,688 inpatient days of care for primary adhesiolysis. An estimated 334,644 days of care were attributed to secondary adhesiolysis. For hospitalizations in which adhesiolysis was a secondary procedure, we compared the LOS between adhesiolysis and nonadhesiolysis procedures to estimate the LOS attributable to adhesiolysis by each DRG. The majority of DRGs showed an increase in LOS for adhesiolysis hospitalizations versus nonadhesiolysis hospitalizations. On average, hospitalizations related to secondary adhesiolysis resulted in an additional 1.24 hospitalized days compared with nonadhesiolysis-related hospitalizations.
Inpatient Care Attributable to Abdominal Adhesiolysis by Surgical Procedure in the US in 2005
The difference in mean LOS was greatest for extensive operation room procedures unrelated to principal diagnosis (i.e., DRG 468), with 4.9 days attributable to adhesiolysis. For stomach, esophageal, and duodenal procedures with complications of comorbid conditions (i.e., DRG 154), 4.6 days were attributable to adhesiolysis. Almost half (46.3%) of all secondary adhesiolysis procedures (125,069) were female reproductive tract related, resulting in 57,005 days of care. Thus, 0.46 day of additional stay were attributable to adhesiolysis. The longest LOS for female reproductive system procedures was for DRG 358 (uterine and adnexa procedures for nonmalignancy), which resulted in an additional day of inpatient stay (0.90 day).
Table Table66 shows that total inpatient expenditures for adhesiolysis-related hospitalizations were $2.25 billion: of this amount, primary adhesiolysis-related hospitalizations accounted for $1.35 billion and secondary adhesiolysis-related hospitalizations accounted for $902 million. Of the total secondary adhesiolysis expenditures, $622 million (69%) were related to procedures for the digestive system and $220 million (24.3%) were related to procedures for the female reproductive system. Adhesiolysis related to the hepatobiliary system and pancreas and Cesarean sections accounted for $41 million and $18 million, respectively.
Inpatient Expenditures Attributable to Abdominal Adhesiolysis in the US in 2005
The rate of adhesiolysis-related hospitalizations in the US has remained fairly constant from 1998 to 2005: from 115.5 in 1988  to 117.3 in 1994  and ultimately 118.6 per 100,000 persons in 2005. In these same time periods, the average LOS for primary adhesiolysis-related hospitalizations has steadily decreased from 11.2 days to 9.7 days and 7.8 days, respectively. The costs for such hospitalizations, when inflated to reflect 2007 dollars, indicated an increase of $112 million between 1988 and 2005, despite the 3.4-day (or 30%) decrease in LOS--this represented a 5% increase in medical care costs. This increase suggested that costs of treating adhesiolysis have increased substantially.
Primary adhesiolysis contributed 23% of all adhesiolysis procedures (81,532) but represented more than half of the total cost burden ($1.3 billion). Secondary adhesiolysis was substantially higher in volume, representing 77% of procedures (270,245) but less half of the total cost burden ($902 million). The greatest number of procedures was to the female reproductive tract (125,069) while procedures to the digestive tract yielded the highest overall costs ($622 million).
Potentially mitigating this growth in the cost of adhesiolysis may be the continuing trend in the US toward minimally invasive and laparoscopic approaches, which may lessen the occurrence of postoperative adhesions . Although laparoscopy reduces surgical trauma, the procedure has not been show to reduce the incidence of adhesion-related readmissions .
This study is subject to potential limitations consistent with retrospective database studies. Conditions and events of interest were identified by diagnosis codes. Previous research has suggested that the condition may be underreported . This may mean that the actual cost of adhesiolysis-related disease is greater than the estimate provided by our study. The database used for this study was not specifically designed to assess inpatient burden. Like all administrative billing databases, the data contained in the HCUP NIS are dependent upon the quality of coding, which may be influenced by reimbursement incentives. However, we do not feel it likely that such incentives greatly affected our results since the majority of overall adhesiolysis costs were a part of secondary adhesiolysis procedures and not the more costly primary adhesiolysis. Moreover, even if such incentives exist and are reflected in the data used for this study, these data are indicative of real world practice. Additionally, with such a large sample, the effect of any coding errors or anomalies would likely be minimized.
Furthermore, due to the nature of the database, detailed clinical characteristics could not be ascertained; therefore, the results could not be adjusted for disease severity or other clinical parameters. However, it is unlikely that these factors would have had a large impact on the results, as this study focused on those patients receiving inpatient care. Additionally, since the database contains US data only, the results may not be generalizable to other populations outside of the US. Lastly, because the focus of this study was on direct cost measures, the results do not account for productivity loss for the patient or caregiver and potential future societal contributions that may be lost due to death resulting from or related to adhesiolysis. Because we examined only the direct health care costs associated with inpatient adhesiolysis, we have not examined any adhesiolysis-related surgeries performed at other sites of care, such as ambulatory surgical centers. Further, our study does not capture direct costs relating to but occurring before or after surgery, including pain medications, cost of work-up visits, and procedures related to diagnosis. Similarly, patient work-ups and diagnostic laparoscopic procedures that may have occurred at separate visits and prior to the adhesiolysis surgery were not captured if specific DRG codes were not listed for those hospitalizations [6,7,9]. Hence, this study's estimates of costs are likely to be conservative.
Adhesions remain an important surgical problem, and hospitalization for adhesiolysis leads to a high direct cost burden in the US. Despite a trend of decreasing LOS for adhesiolysis-related hospitalizations from 2001 to 2005, adhesiolysis-related costs continue to rise even while the overall rate of adhesiolysis procedures remains constant. Consistent with previous research, the distribution of inpatient care and costs across the diagnostic categories remained steady from 2001 to 2005, with only a slight increase in primary adhesiolysis procedures over time. From 2001 to 2005, hospitalizations for adhesiolysis related to the digestive system and to the female reproductive tract had the largest number of inpatient days and accounted for the majority of costs related to secondary adhesiolysis procedures.
Adhesiolysis remains a substantial economic burden to the US health care system, which should be of interest to providers and commercial and government payers. Further research incorporating detailed clinical data and indirect costs would aid in a greater understanding of the overall burden of adhesiolysis.
VS was an employee of Ethicon, Inc. at the time that this manuscript was prepared; he is currently an employee of Shire Pharmaceuticals. BB, SDC, and KLD are employees of RTI Health Solutions, the research organization contracted by Ethicon to conduct this study. AJ is an employee of Texas Healthcare; MW is an employee of Christie NHS Foundation Trust.
VS was responsible for developing the study design, interpreting the analysis results, and drafting the manuscript text; he is the primary author of this manuscript. BB, SDC, and KLD were responsible for the acquisition, management, interpretation, and analysis of all study data. BB, SDC, and KLD also assisted with developing the study design, interpreting the analysis results, and drafting the manuscript. AJ and MW contributed clinical expertise and guidance and assisted in interpreting the analysis results and drafting the manuscript text.
All authors confirm that they have read the journal's position on issues involved in ethical publication and affirm that this research report is consistent with those guidelines. Finally, all authors have read and approved the final manuscript.
This study and the preparation of this manuscript were funded by Ethicon, Inc. The authors acknowledge that Ethicon, Inc. is the maker of GYNECARE INTERCEED, a product that is marketed to prevent pelvic adhesions.
The pre-publication history for this paper can be accessed here:
Portions of the study data presented in this paper were previously presented as a podium presentation at the VIIIth PAX Meeting; Clermont-Ferrand, France; September 18-20, 2008, as well as a poster presentation at the 57th Annual Clinical Meeting of the American College of Obstetricians and Gynecologists; Chicago, Illinois; May 2-6, 2009.
The authors wish to thank Ms. Gail Zona of RTI Health Solutions and Ms. Heidi Waters of Ethicon, Inc., for assistance with preparing this manuscript.
- Beck DE. Understanding abdominal adhesions. Ostomy Q. 2001;38(2):50–51.
- Ray NF, Denton WG, Thamer M, Henderson SC, Perry S. Abdominal adhesiolysis: inpatient care and expenditures in the United States in 1994. J Am Coll Surg. 1998;186(1):1–9. doi: 10.1016/S1072-7515(97)00127-0. [PubMed] [Cross Ref]
- Menzies D, Parker M, Hoare R, Knight A. Small bowel obstruction due to postoperative adhesions: treatment patterns and associated costs in 110 hospital admissions. Ann R Coll Surg Engl. 2001;83:40–46. [PMC free article] [PubMed]
- diZerega GS, Tulandi T. Prevention of intra-abdominal adhesions in gynaecological surgery.Reprod Biomed Online. 2008;17:303–306. doi: 10.1016/S1472-6483(10)60211-8. [PubMed][Cross Ref]
- Tingstedt B, Isaksson J, Andersson R. Long-term follow-up and costs analysis following surgery for small bowel obstruction caused by intra-abdominal adhesions. Br J Surg. 2007;94:743–748. doi: 10.1002/bjs.5634. [PubMed] [Cross Ref]
- Ellis H, Moran BJ, Thompson JN, Parker MC, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJ, O'Brien F, Buchan S, Crowe AM. Adhesion-related hospital readmissions after abdominal and pelvic surgery: a retrospective cohort study. Lancet. 1999;353:1476–1480. doi: 10.1016/S0140-6736(98)09337-4. [PubMed] [Cross Ref]
- Parker MC, Ellis H, Moran BJ, Thompson JN, Wilson MS, Menzies D, McGuire A, Lower AM, Hawthorn RJ, O'Briena F, Buchan S, Crowe AM. Postoperative adhesions: ten-year follow-up of 12,584 patients undergoing lower abdominal surgery. Dis Colon Rectum. 2001;44:822–829. doi: 10.1007/BF02234701. [PubMed] [Cross Ref]
- Lower AM, Hawthorn RJ, Ellis H, O'Brien F, Buchan S, Crowe AM. The impact of adhesions on hospital readmissions over ten years after 8489 open gynaecological operations: an assessment from the Surgical and Clinical Adhesions Research Study. Br J Obstet Gynaecol.2000;107:855–862. doi: 10.1111/j.1471-0528.2000.tb11083.x. [PubMed] [Cross Ref]
- Meagher AP, Moller C, Hoffmann DC. Non-operative treatment of small bowel obstruction following appendectomy or operation on the ovary or tube. Br J Surg. 1993;80:1310–1311. doi: 10.1002/bjs.1800801030. [PubMed] [Cross Ref]
- Ray NF, Larsen JW, Stillman RJ, Jacobs RJ. Economic impact of hospitalizations for lower abdominal adhesiolysis in the United States in 1988. Surg Gynecol Obstet. 1993;176:271–276.[PubMed]
- HCUP Nationwide Inpatient Sample. Healthcare Cost and Utilization Project (HCUP)http://www.hcup-us.ahrq.gov/nisoverview.jsp
- Steiner C, Elixhauser A, Schnaier J. The Healthcare Cost and Utilization Project: an overview.Eff Clin Pract. 2002;5(3):143–151. [PubMed]
- US Bureau of Labor Statistics. Consumer Price Index for medical services.http://data.bls.gov/PDQ/outside.jsp?survey=cu
- SAS Institute Inc. SAS 9.1.3. Cary, NC: SAS Institute Inc; 2003.
- Research Triangle Institute. SUDAAN (Release 9.0.1) Research Triangle Park, NC: Research Triangle Institute; 2005.
- Gutt CN, Oniu T, Schemmer P, Mehrabi A, Büchler MW. Fewer adhesions induced by laparoscopic surgery? Surg Endosc. 2004;18(6):898–906. doi: 10.1007/s00464-003-9233-3.[PubMed] [Cross Ref]
- Parker MC, Wilson MS, Menzies D, Sunderland G, Clark DN, Knight AD, Crowe AM. Surgical and Clinical Adhesions Research (SCAR) Group. The SCAR-3 study: 5-year adhesion-related readmission risk following lower abdominal surgical procedures. Colorectal Dis. 2005;7:551–558. doi: 10.1111/j.1463-1318.2005.00857.x. [PubMed] [Cross Ref]
Articles from BMC Surgery are provided here courtesy of BioMed Central
Friday, December 20, 2013
Dammed if you do and dammed if you don't!
SIGNING A DRUG CONTRACT ~ FROM PATIENT PERSPECTIVE ~ GIVING UP YOUR RIGHTS
Chronic pain patients are required to sign contracts with their pain management physician. Many of the stipulations in these contracts remove the patient's rights to privacy of their medical information as well as removing the constitutional rights that require law enforcement to obtain a warrant (meaning need to show probable cause to get such a warrant) in order to get the medical record. These contracts also often contain false information regarding what is drug seeking behavior, physical dependence, and tolerance to pain medication. Also they rely upon presumptive testing that is widely known to be inaccurate in order to deny treatment. Basically these contracts are set up in such a way that every chronic pain patient will eventually violate some part of the contract and lose treatment. Depression is NOT drug seeking behavior, it is a common occurrence with ANY chronic illness, not just chronic pain.
To learn more, including information about the so-called studies that the DEA rely upon to call prescription drug abuse an "epidemic" when the numbrs don't support it. To learn more about chronic pain, contracts, and more:
http://pain-topics.org/ for updates on studies http://updates.pain-topics.org/
To learn more about Richard Paey, an example of the unfair investigation procedures and prosecution on chronic pain patients see here:
Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update
World J Emerg Surg. 2013 Oct 10;8(1):42. doi: 10.1186/1749-7922-8-42.
Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group.
Di Saverio S, Coccolini F, Galati M, Smerieri N, Biffl WL, Ansaloni L, Tugnoli G, Velmahos GC, Sartelli M, Bendinelli C, Fraga GP, Kelly MD, Moore FA, Mandalà V, Mandalà S, Masetti M, Jovine E, Pinna AD, Peitzman AB, Leppaniemi A, Sugarbaker PH, Goor HV, Moore EE, Jeekel J, Catena F.
In 2013 Guidelines on diagnosis and management of ASBO have been revised and updated by the WSES Working Group on ASBO to develop current evidence-based algorithms and focus indications and safety of conservative treatment, timing of surgery and indications for laparoscopy.
In absence of signs of strangulation and history of persistent vomiting or combined CT-scan signs (free fluid, mesenteric edema, small-bowel feces sign, devascularization) patients with partial ASBO can be managed safely with NOM and tube decompression should be attempted. These patients are good candidates for Water-Soluble-Contrast-Medium (WSCM) with both diagnostic and therapeutic purposes. The radiologic appearance of WSCM in the colon within 24 hours from administration predicts resolution. WSCM maybe administered either orally or via NGT both immediately at admission or after failed conservative treatment for 48 hours. The use of WSCM is safe and reduces need for surgery, time to resolution and hospital stay.NOM, in absence of signs of strangulation or peritonitis, can be prolonged up to 72 hours. After 72 hours of NOM without resolution, surgery is recommended.Patients treated non-operatively have shorter hospital stay, but higher recurrence rate and shorter time to re-admission, although the risk of new surgically treated episodes of ASBO is unchanged. Risk factors for recurrences are age ...more
Free full text
Tuesday, December 17, 2013
Reuters - 4 hours ago
LONDON (Reuters) - GlaxoSmithKline will stop paying doctors for promoting its drugs and scrap prescription targets for its marketing staff
Monday, December 16, 2013
1 Completed Closure of Peritoneum at Cesarean Section and Postoperative Adhesion
Conditions: Cesarean Section; Adhesions
Intervention: Procedure: Closure of the peritoneum at cs
2 Completed Efficacy and Safety Study of Anti-Adhesion Product in the Prevention of Intraperitoneal Adhesions
Condition: Intraperitoneal Adhesions
Intervention: Biological: Anti-Adhesion Product
3 Active, not recruiting Seprafilm® Adhesion Barrier and Cesarean Delivery
Conditions: Adhesions; Cesarean Section; Delivery, Obstetric
Interventions: Device: modified sodium hyaluronic acid and carboxymethylcellulose (Seprafilm Adhesion Barrier); Device: Placebo
4 Not yet recruiting Adhesions After Open Versus Laparoscopic Resection of Colorectal Malignancies Detected During Liver Resection
Intervention: Procedure: Liver resection
5 Completed Safety and Efficacy Study of a Hydrogel, Applied Following Removal of Myomas During Gynecologic Surgery, Administered for the Prevention/Reduction of Postoperative Adhesion Formation
Interventions: Other: Adhibit Adhesion Prevention Gel; Other: Standard of Care Comparator
Has Results DuraGen Plus® Adhesion Barrier for Use in Spinal Surgery
Conditions: Spinal Injuries; Adhesions
Intervention: Device: DuraGen Plus Adhesion Barrier Matrix
7 Terminated Seprafilm® for Prevention of Adhesions at Repeat Cesarean
Condition: Adhesion Formation After Primary Cesarean Delivery
Interventions: Device: Seprafilm®; Other: Control
8 Terminated Efficacy of Sprayable PEG Barrier in Gynecologic Laparoscopy
Conditions: Postoperative Adhesion; Peritoneal Adhesion, Nos
Interventions: Device: Spraygel; Device: Control
9 Not yet recruiting A Trial to Reduce Adhesions Following a Primary Cesarean Section
Condition: Tissue Adhesions
Intervention: Device: Seprafilm
10 Completed Efficacity Assessment of PREVADH® in Adhesion Prevention in Gynaecologic Surgery
Conditions: Uterine Fibroids; Fertility Disorders
Interventions: Other: Ringer lactate solution; Device: Prevadh film
11 Completed Evaluation of Bioresorbable Sheet to Prevent Intra-Abdominal Adhesions in Colorectal Surgeries
Intervention: Device: Polylactic Acid Sheet
12 Recruiting Intravitreal Gas for Vitreomacular Adhesion
Condition: Vitreomacular Adhesion
Intervention: Procedure: Intravitreal Injection of sulfahexafluoride gas
13 Recruiting Comparative Effectiveness Multicenter Trial for Adhesion Characteristics of Ventral Hernia Repair Mesh
Conditions: Ventral Hernia; Adhesions
Intervention: Procedure: Clinically-Indicated Abdominal Re-Exploration Surgery
14 Suspended Evaluation of Adhexil Safety and Efficacy in Prevention and/or Reduction of Adhesions in Gynecological Surgery
Conditions: Ovarian Cysts; Endometriosis; Adhesions
Intervention: Biological: ADHEXIL
15 Terminated Evaluation of the Safety and Effectiveness of Sepraspray™ in Reducing Post-surgical Adhesions
Condition: Abdominal Adhesions
Intervention: Device: Sepraspray
16 Not yet recruiting A Trial to Assess the Effect and Safety of the C-Qur™ Film
Condition: Postoperative Adhesions
Intervention: Device: C-Qur
17 Completed Collagenase in the Treatment of Zone II Flexor Tendon Adhesions in the Hand
Condition: Adhesion of Flexor Tendon of Hand
Interventions: Drug: Collagenase; Drug: Collagenase injection
18 Recruiting The Role of 2-octyl Cyanoacrylate in Prevention of Recurrent Adhesions After Circumcision
Conditions: Phimosis; Adhesions
Interventions: Procedure: application of 2-octyl cyanoacrylate skin adhesive in addition to stitches; Procedure: standard stitches only
19 Terminated SprayShield EU Post Market Study
Conditions: Ulcerative Colitis; Familial Polyposis
Interventions: Device: SprayShield Adhesion Barrier System; Procedure: Good Surgical Technique Alone
20 Recruiting Effects of CoSeal on Bleeding & Adhesions in Pediatric Heart Surgery
Conditions: Congenital Heart Defect; Surgery-Induced Tissue Adhesions; Hemorrhage
Intervention: Device: CoSeal Surgical Spray Group
Safety and Efficacy Study of Intravitreal Ocriplasmin in Subjects With AMD With Focal Vitreomacular Adhesion
Exudative Age-Related Macular Degeneration; Focal Vitreomacular Adhesion
Drug: Ocriplasmin; Drug: Sham injection
22 Terminated Pregabalin for Abdominal Pain From Adhesions
Conditions: Abdominal Pain; Surgical Adhesions
Intervention: Drug: Pregabalin
23 Completed A-Part® Gel as Adhesion Prophylaxis After Major Abdominal Surgery Versus a Non-treated Group
Conditions: Adhesions; Abdominal Cavity
Intervention: Device: A-Part® Gel
24 Active, not recruiting Assessment of the Manageability and Safety of ADBLOCK Adhesion Barrier System in Laparoscopic Gynaecological Surgery
Condition: UTERINE MYOMAS
Intervention: Device: ADBLOCK
25 Completed Has Results
Post Market Study for an Adhesion Barrier Following Laparoscopic Myomectomy
Conditions: Fibroid; Myoma; Leiomyoma
Intervention: Device: SprayShield™
26 Completed Resorbable Barrier for the Prevention of Abdominal and Peri-hepatic Adhesion Formation
Condition: Colorectal Cancer
Interventions: Procedure: - use of resorbable membrane Seprafilm; Procedure: without resorbable barrier (seprafilm)
27 Recruiting Seprafilm Slurry in the Prevention of Uterine Scarring in Patients Undergoing Hysteroscopic Myomectomy
Condition: Intrauterine Adhesions
Interventions: Device: Seprafilm; Device: Sterile Saline Solution
28 Completed Adhesion Formation Following Laparoscopic and Open Colorectal Surgery
Intervention: Procedure: Laparoscopy
29 Completed Has Results
Trial of Microplasmin Intravitreal Injection for Non-surgical Treatment of Focal Vitreomacular Adhesion. The MIVI-TRUST (TG-MV-006) Trial.
Condition: Vitreomacular Adhesion
Interventions: Drug: 125 µg Ocriplasmin; Drug: Placebo
30 Completed Interferon Gamma to Treat Leukocyte Adhesion Deficiency Type I
Condition: Leukocyte Adhesion Deficiency Syndrome
Intervention: Drug: Interferon gamma
31 Completed Has Results
Trial of Microplasmin Intravitreal Injection for Non-Surgical Treatment of Focal Vitreomacular Adhesion. The MIVI-TRUST (TG-MV-007) Trial.
Condition: Vitreomacular Adhesion
Interventions: Drug: Ocriplasmin 125µg; Drug: Placebo
32 Recruiting a Study to Evaluate Adhesion Risk in Fertility Patients' Status Post Laparoscopic Myomectomy.
Conditions: Uterine Fibroids; Infertility
Intervention: Device: surgery utilizing V-Loc suture
33 Completed Efficiency of Intercoat (Oxiplex/AP Gel)in Decreasing Intrauterine Adhesions
Condition: Asherman Syndrome
Interventions: Drug: Oxiplex/AP gel; Drug: Normal Saline
34 Completed Safety Study of Polylactide-Caprolactone-Trimethylenecarbonate Copolymer for Post-Operative Adhesion Prophylaxis
Interventions: Device: polylactide-caprolactone-trimethylenecarbonate copolymer; Device: Icodextrin 4%
35 Completed Stem Cell Transplantation to Treat Leukocyte Adhesion Deficiency
Condition: Leukocyte-Adhesion Deficiency Syndrome
Intervention: Procedure: modified stem cell transplant
36 Completed Safety and Efficacy Study of Microplasmin in for Non-Surgical Treatment of Focal Vitreomacular Adhesion
Condition: Focal Vitreomacular Adhesion
Intervention: Drug: Microplasmin
37 Completed Efficacy and Safety of the Investigational Device, SurgiShield Anti-Adhesion Barrier Gel
Condition: Wound Healing
Intervention: Device: 5ml surgishield
38 Recruiting A Phase III Study of A01016 in Subjects With Symptomatic Vitreomacular Adhesion
Condition: Vitreomacular Adhesion
Interventions: Drug: A01016; Drug: Sham injection
39 Recruiting Propanolol and Red Cell Adhesion Non-asthmatic Children Sickle Cell Disease
Condition: Sickle Cell Disease
Intervention: Drug: propranolol
40 Recruiting Adhesion of Connective Tissue Around Laser-treated Abutments for Dental Implants - Clinical Trial in Humans
Intervention: Procedure: Dental implant placement with a final pro