Showing posts with label surgery. Show all posts
Showing posts with label surgery. Show all posts
Sunday, July 13, 2014
Saturday, July 12, 2014
Medisse, A Dutch biomaterial company, successfully treated the first patient with the FlexiSurge Adhesion Barrier
Eh...talk to me in about 5 years....
EDE, The Netherlands--(BUSINESS WIRE)--Medisse BV, a leading innovator and developer of synthetic resorbable soft tissue implants, today announced the successful treatment of the first patient in a clinical trial for its first innovation, FlexiSurge® Adhesion Barrier, which is designed to reduce adhesions formed after open colorectal surgery procedures. The study, currently underway in the Netherlands, marks a significant milestone in the development of the Company’s first product to revolutionize patient care.
“We are happy to have successfully treated the first patient in the FlexiSurge study”
The study, being conducted in three hospitals in the Netherlands, will http://www.businesswire.com/news/home/20140708005121/en/Medisse-Dutch-biomaterial-company-successfully-treated-patient#.U8G-yvldWHginvestigate the safety of
Friday, May 16, 2014
Medical Headlines for People w Adhesions ARD
Medical Headlines for People w Adhesions ARD
Cost-control plan for health care could cost you photo
WASHINGTON (AP) — You just might want to pay attention to the latest health insurance jargon. It could mean thousands of dollars out of your pocket. The Obama administration has given the go-ahead for a new cost-control strategy called "reference pricing." It lets insurers and employers put a...
WASHINGTON (AP) — You just might want to pay attention to the latest health insurance jargon. It could mean thousands of dollars out of your pocket. The Obama administration has given the go-ahead for a new cost-control strategy called "reference pricing." It lets insurers and employers put a...
Surgery safer with teamwork, training [external]
Briefings of doctors and nurses on teams before and after each operation cut the death rate 18%, a study finds.
Briefings of doctors and nurses on teams before and after each operation cut the death rate 18%, a study finds.
Reading Pain in a Human Face [external]
Researchers have found that a computer is much better than people are at telling the difference between real and faked pain, a discovery that may lead to methods to detect children’s pain and to treat depression.
Researchers have found that a computer is much better than people are at telling the difference between real and faked pain, a discovery that may lead to methods to detect children’s pain and to treat depression.
Data Murky on Fertility Rates [external]
In the multibillion-dollar fertility industry, there is little enforcement of regulations that require clinics to report their success rates.
In the multibillion-dollar fertility industry, there is little enforcement of regulations that require clinics to report their success rates.
Tuesday, April 08, 2014
Dr. C.Y. Liu OBGYN M.D. FACOG, FACS
St. Vincent’s Medical Center in New York and Chattanooga Tennessee.
http://www.womenssurgerygroup.com
Dr. C.Y. Liu is an internationally recognized leader and pioneer in the subspecialty of gynecological endoscopic surgery (laparoscopic and hysteroscopic) surgery. For the past 15 years, Dr. Liu has devoted his work exclusively to gynecological endoscopic surgery. Recognized internationally is his pioneer work in urogynecological laparoscopic surgery (a specialty dealing with female organ prolapse and urinary and fecal incontinence).He holds the record for performing the most laparoscopic hysterectomy in the world and has extensive professional publications and presentations to his credit. Dr. Liu is one of the most sought-after surgeons for the performance of interactive live surgical demonstration at large international medical meetings both in United States and abroad. He was recognized and awarded by the European Gynecologic Endoscopic Society as one of the most achieved and excellent Gynecologic Endoscopic Surgeon in the world in September 2000, Paris, France.
Dr. C.Y. Liu’s practice is limited to gynecological laser laparoscopic surgery, and he maintains a practice at St. Vincent’s Medical Center in New York and Chattanooga Tennessee.
Adhesion Specialist
Dr. C.Y. Liu OBGYN M.D. FACOG, FACS
View Curriculum Vitae
A Comparative Analysis between Laparoscopic and Open Adhesiolysis at a Tertiary Care Center.
Am Surg. 2014 Mar;80(3):261-9.
A Comparative Analysis between Laparoscopic and Open Adhesiolysis at a Tertiary Care Center.
Abstract
Laparotomy has been the favored approach regarding surgical management of small bowel obstruction (SBO); however, laparoscopy may offer improved outcomes. Patients undergoing laparoscopic lysis of adhesions (LOA) at our institution for SBO will have lower postoperative morbidity and 30-day mortality. Patients undergoing LOA at our institution, from 2000 to 2011, were reviewed. Categorical data were analyzed with χ(2) or Fisher's exact tests. Continuous data were analyzed with Student's t test or Wilcoxon rank sum. One hundred two (38 laparoscopic, 64 open) LOA cases were selected. Perioperative contamination and conservative management were higher in the open group. Open cases had a greater incidence of intensive care unit (ICU) admissions and longer length of stay. Stratified analysis determined a strong association between perioperative contamination and a higher incidence of ICU admission, perioperative contamination and longer LOS, and conservative management and longer LOS. Finally, patient outcome did not differ between those treated by surgeons trained in minimally invasive surgery (MIS) compared with those not trained in MIS. Careful consideration of surgical approach and timing is called for in all patients with SBO; however, whenever possible, laparoscopic preference should be given to most patients in an expeditious fashion irrespective of MIS training.
- PMID:
- 24666867
- [PubMed - in process]
Monday, April 07, 2014
Sunday, April 06, 2014
Adhesiolysis in Germany Dr. Matthias Korell and Dr. Jens Pagel
Adhesiolysis in Germany Dr. Matthias Korell and Dr. Jens Pagel
Dr. Matthias Korell
Johanna-Etienne Hospital Neuss
Dr. Matthias Korell
Johanna-Etienne Hospital Neuss
On Hasenbergstraße 46
41462 Neuss
North Rhine-Westphalia
Germany
41462 Neuss
North Rhine-Westphalia
Germany
Phone : 02131/5295-5002
Fax: 02131/5295-5003
Fax: 02131/5295-5003
PD Dr. Matthias Korell practiced as:
- Specialist in Obstetrics u.Geburtshilfe
- PD Dr. Matthias Korell speaks: German.Vocational group is senior consultant or senior doctor.
- ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dr. Jens Pagel
St. Joseph's Hospital Department of Obstetrics and Gynecology
Asberger Strasse 4
47441 Moers
North Rhine-Westphalia
Germany
47441 Moers
North Rhine-Westphalia
Germany
Phone : 02841/107-2430
Fax: 02841/107-2000
Fax: 02841/107-2000
Dr. Jens Pagels practiced as:
- Specialist in Obstetrics u.Geburtshilfe
- Dr. Jens Pagels speaks: German. Vocational group is senior consultant or senior doctor.
Histone deacetylase inhibitors decrease intra-abdominal adhesions with one intraoperative dose by reducing peritoneal fibrin deposition pathways.
Surgery. 2014 Feb;155(2):234-44. doi: 10.1016/j.surg.2013.08.018. Epub 2013 Nov 14.
Histone deacetylase inhibitors decrease intra-abdominal adhesions with one intraoperative dose by reducing peritoneal fibrin deposition pathways.
Abstract
BACKGROUND:
We previously demonstrated that postoperative peritoneal injury and inflammation contribute to adhesiogenesis. Recent evidence suggests that in addition to their role of interfering with the acetylation status of nuclear histone proteins, histone deacetylase inhibitors (HDACIs) including valproic acid (VPA) can target nonhistone proteins to resolve inflammation and modulate immune cells. We hypothesized that HDACIs could reduce adhesions.
METHODS:
Seventy-two rats underwent laparotomy with creation of 6 peritoneal ischemic buttons to induce adhesions. A single intraperitoneal (IP) dose of 50 mg/kg VPA was administered intraoperatively, whereas controls received vehicle. To evaluate the timing, 25 rats underwent ischemic button creation with either an intraoperative or a delayed IP dose of VPA at 1, 3, or 6 hours postoperatively. On postoperative day 7, adhesions were quantified. To investigate mechanisms, ischemic buttons were created in 24 rats and either VPA or saline was administered in 1 intraoperative dose. At 3 or 24 hours later, peritoneal fluid was collected and fibrinolytic activity measured. Alternatively, button tissue was collected 30 minutes postoperatively to measure tissue factor, fibrinogen, and vascular endothelial growth factor (VEGF) by real-time polymerase chain reaction or Western blot.
RESULTS:
A single intraoperative dose of VPA reduced adhesions by 50% relative to controls (P < .001). Delayed dosing did not reduce adhesions. In operated animals, peritoneal fibrinolytic activity was not different between groups. Tissue factor mRNA was downregulated by 50% (P = .02) and protein by 34% (P < .01) in animals administered VPA versus saline. VPA decreased fibrinogen protein by 56% and VEGF protein by 25% compared with saline (P = .03).
CONCLUSION:
These findings suggest that VPA rapidly reduces the extravasation of key adhesiogenic substrates into the peritoneum. A single, intraoperative intervention provides an ideal dosing strategy and indicates an exciting new role for HDACIs in adhesion prevention.
Copyright © 2014 Mosby, Inc. All rights reserved.
- PMID:
- 24239397
- [PubMed - indexed for MEDLINE]
Monday, March 31, 2014
Poor Pup is also a Victim of adhesions
Lulu Undergoes Five-Hour Surgery at Angell Memorial Hospital
Doctors found more internal problems during Lulu's operation. She is being monitored for the next several days at Angell Memorial Hospital.
Brought to you by findmassmoney.com
Lulu. Photo credit: GoFundMe page.
Kimberly Hammond Donahue updated all of Lulu’s fans about how the German Shepherd is doing after Lulu underwent a five-hour surgery at Angell Memorial Hospitalon Monday.
On the GoFundMe fundraising pagethat Donahue created to raise funds for Lulu’s surgery, Donahue wrote on Monday:
“I am so eternally grateful for everyone that has helped me with this endeavor... I truly am and will be forever... Lulu had almost 5 hours of surgery today... She is being monitored for several days to avoid any complications, but we are not unfortunately out of the woods yet. They found so many more problems internally than originally thought... She had multiple adhesions and scar tissue internally...from who knows what... nor do I want to know. They were able to relieve a band of adhesions that were limiting and constricting her esophagus, resulting in the mega esophagus. They also discovered that one of her lungs was actually adhered to her abdominal cavity... they were able to free it and feel that they did not puncture or compromise her lung. This will be a long road of recovery and depending upon the outcome I may do more fund raising. I believe that all things happen for a reason...she came to all of us, and we have come a long way, and made tremendous strides. Please keep checking back as I want all of the prayers that can be offered... I will post updates as I know more...THANK GOD for Angell Memorial Hospital ....”
Lulu was abandoned at the Spoiled Rotten Doggy Daycare and Donahue volunteered to take her in. The dog has a medical condition called esophageal diverticulitis, which requires immediate corrective surgery to allow her to eat and not regurgitate her food. The problem hasn’t been treated for years, said Donahue.
If she didn’t get the surgery, her condition would have worsened and could have lead to a secondary condition, such as an infection in her lungs, which can be fatal.
Lulu’s story went international after Donahue started fundraising for the dog's operation last month. Money flowed it from around the world as people opened up their wallets for Lulu.
Donahue has raised nearly $18,000 for the operation and post-operation care for Lulu. Any money raised beyond that will be given to the Northeast Animal Shelter.
Friday, March 28, 2014
Integra Buys Covidien’s Confluent Surgical Product Lines
Integra Buys Covidien’s Confluent Surgical Product Lines
| By HospiMedica International staff writers Posted on 18 Nov 2013 |
Integra LifeSciences (Plainsboro Township, NJ, USA) is to acquire the Covidien (Dublin, Ireland) Confluent Surgical product line, including surgical sealants, adhesion barrier, and, most significantly, DuraSeal.
The DuraSeal system technology is a synthetic, absorbable, hydrogel delivered by a dual syringe applicator. When sprayed onto the dura, a strong, adherent sealing layer is produced, which effectively seals the suture line within seconds. A feature unique to DuraSeal is the blue colorant that provides the surgeon excellent visualization of coverage and thickness of the material upon application. The addition of a dural sealant technology to Integra’s current line enables the surgeon to adopt a “one stop shop” approach to closing the Dura Mater following neurosurgical procedures, complementing the company’s dural substitute, Duragen.
The other products in the Confluent Surgical product line include DuraSeal Exact/Xact, VascuSeal, and SprayShield. The products are part of the soft tissue repair category at Covidien, and generated approximately USD 65 million in sales in fiscal 2012. Under the terms of the agreement, Covidien will receive an initial cash payment of USD 235 million from Integra. Additionally, Covidien may receive up to USD 30 million, contingent upon the achievement of certain performance measures related to the transition of the Confluent Surgical business to Integra.
“The addition of the DuraSeal product lines enables our sales force and distributor partners to provide their customers with a best-in-class dural sealant as they seek to support surgeon’s efforts to minimize cerebrospinal fluid leaks upon completion of the surgical procedure,” said Robert Davis, President of Integra’s US Neurosurgery division. “Together with our broad DuraGen product line we are fortunate to have even more options to serve our customers and the individual needs of their patients.”
“This transaction allows Covidien to better focus on its global strategic priorities,” said Bryan Hanson, group president of medical devices & US at Covidien. “Based on Integra’s presence in neurosurgery and spine surgery combined with a strong portfolio of clinical evidence, we believe these products will thrive under Integra’s ownership. We express our sincere gratitude to our dedicated employees and the clinicians who have partnered with us throughout the years.”
Related Links:
Integra LifeSciences
Covidien
The DuraSeal system technology is a synthetic, absorbable, hydrogel delivered by a dual syringe applicator. When sprayed onto the dura, a strong, adherent sealing layer is produced, which effectively seals the suture line within seconds. A feature unique to DuraSeal is the blue colorant that provides the surgeon excellent visualization of coverage and thickness of the material upon application. The addition of a dural sealant technology to Integra’s current line enables the surgeon to adopt a “one stop shop” approach to closing the Dura Mater following neurosurgical procedures, complementing the company’s dural substitute, Duragen.
The other products in the Confluent Surgical product line include DuraSeal Exact/Xact, VascuSeal, and SprayShield. The products are part of the soft tissue repair category at Covidien, and generated approximately USD 65 million in sales in fiscal 2012. Under the terms of the agreement, Covidien will receive an initial cash payment of USD 235 million from Integra. Additionally, Covidien may receive up to USD 30 million, contingent upon the achievement of certain performance measures related to the transition of the Confluent Surgical business to Integra.
“The addition of the DuraSeal product lines enables our sales force and distributor partners to provide their customers with a best-in-class dural sealant as they seek to support surgeon’s efforts to minimize cerebrospinal fluid leaks upon completion of the surgical procedure,” said Robert Davis, President of Integra’s US Neurosurgery division. “Together with our broad DuraGen product line we are fortunate to have even more options to serve our customers and the individual needs of their patients.”
“This transaction allows Covidien to better focus on its global strategic priorities,” said Bryan Hanson, group president of medical devices & US at Covidien. “Based on Integra’s presence in neurosurgery and spine surgery combined with a strong portfolio of clinical evidence, we believe these products will thrive under Integra’s ownership. We express our sincere gratitude to our dedicated employees and the clinicians who have partnered with us throughout the years.”
Related Links:
Integra LifeSciences
Covidien
Sunday, March 23, 2014
Vaginal mesh for pelvic organ prolapse: Information for healthcare professionals
Vaginal mesh implants used to treat pelvic organ prolapse (POP) include a range of different types of mesh implanted in the pelvic floor area in a number of different ways to support the vaginal wall and/or internal organs. The mesh can be synthetic, ‘biological’ or a combination of the two and it may be absorbable or non-absorbable.
MHRA investigation into vaginal mesh implants
In light of an increasing number of adverse events and patient concerns being reported, the MHRA launched an investigation to better understand the use of these devices and the complications associated with their use.
MHRA workshop
The MHRA held a workshop in March 2012 under the chairmanship of Professor Paul Abrams, which included representatives of the Royal College of Obstetricians and Gynaecologists, the British Association of Urological Surgeons, the British Society of Urogynaecology, NICE, the University of Aberdeen Health Services Research Unit, and representatives of some manufacturers of these devices, to consider how to make this a safer procedure.
The meeting covered:
- types of vaginal mesh
- clinical experience, training and outcomes of prolapse surgery
- complications arising from the use of vaginal mesh
- NICE/IPAC guidance
- adverse event reporting
- responsibilities of involved parties (clinicians, regulators and manufacturers).
Further information on the outcomes of this workshop can be found in the section Responsibilities of the parties involved in the manufacture, regulation and surgical provision of vaginal meshes
MHRA review
In light of an increasing number of adverse events and patient concerns being reported, the MHRA launched an investigation to better understand the use of vaginal tapes/slings and meshes and the complications associated with their use.
Although MHRA have had very few reports of problems with these devices we have noted concerns about their safety that are being expressed by patients and patients’ groups. We do take the problems and issues reported very seriously and share concern for their safety, and those that have experienced unwanted complications from them.
In February 2012, the MHRA commissioned a systematic review of the available literature on the incidence of the most frequently reported adverse events associated with different meshes/tapes/slings. The results can be found on Summaries of the safety/adverse effects of vaginal meshes for prolapse
We continue to actively investigate and gathering evidence on the safety of these vaginal mesh and tape devices to better inform patients, doctors and surgeons about the risks, benefits and uses of these devices.
Adverse events that should be reported
The MHRA is still gathering information on the use and complications associated with these devices and would encourage reporting of adverse events to us.
Adverse events related to these devices that we expect clinicians to report to us include the following:
Pre-procedural
- mesh appears unsuitable to implant e.g. rough or sharp edges; too hard or brittle; not to specification
- packaging compromised affecting sterility.
Procedural related
- tape/mesh tears or disintegrates when implanting or fixing mesh in place
- bladder perforation.
Post operatively
- patient has an unexpected severe adverse/allergic tissue reaction to the mesh
- bladder perforation.
Longer-term patient follow-up
- evidence of mesh shrinkage, disintegration, hardening, brittleness
- recurrence of prolapse
- bladder perforation
- vaginal perforation
- recurrence of stress or urge incontinence
- mesh erosion/extrusion through tissues - especially where further surgery is needed for partial or total mesh removal
- dyspareunia
- persistent pelvic/groin pain.
Further information
NHS Choices webpage on treatment for prolapse of the uterus (external link).
NICE guidance
The National Institute for Health and Clinical Excellence (NICE) has produced guidance on the use of mesh for pelvic organ prolapse, which is available on the NICE website, along with summaries of the guidance produced for patients.
For the following procedures NICE guidelines state that current evidence on the efficacy and safety of these procedures is inadequate in quantity and quality. Therefore the procedure should only be used with special arrangements for clinical governance, consent and audit or research.
Infracoccygeal sacropexy using mesh for uterine prolapse repair (IPG280)
- Interventional procedure guidance for healthcare professionals (external link).
- Summary of this guidance for patients and carers (external link).
Infracoccygeal sacropexy using mesh for vaginal vault prolapse repair (IPG281)
- Interventional procedure guidance for healthcare professionals (external link).
- Summary of this guidance for patients and carers (external link).
Insertion of mesh uterine suspension sling (including sacrohysteropexy) for uterine prolapse repair(IPG282)
- Interventional procedure guidance for healthcare professionals (external link).
- Summary of this guidance for patients and carers (external link).
Sacrocolpopexy with hysterectomy using mesh for uterine prolapse repair (IPG284)
- Interventional procedure guidance for healthcare professionals (external link).
- Summary of this guidance for patients and carers (external link).
For the procedure Sacrocolpopexy using mesh for vaginal vault prolapse repair (IPG283), current evidence on the safety and efficacy of sacrocolpopexy using mesh for vaginal vault prolapse repair appears adequate to support the use of this procedure provided that normal arrangements are in place for clinical governance and audit.
- Interventional procedure guidance for healthcare professionals (external link).
- Summary of this guidance for patients and carers (external link).
Sunday, March 16, 2014
Transvaginal endoscopy and small ovarian endometriomas: unravelling the missing link?
Gynecol Surg. 2014;11:3-7. Epub 2013 Oct 17.
Abstract
The incidence of endometriosis in the infertile female is estimated to be between 20 and 50 %. Although the causal relationship between endometriosis and infertility has not been proven, it is generally accepted that the disease impairs reproductive outcome. Indirect imaging techniques and transvaginal laparoscopy now offer the possibility of an early stage diagnosis. Although it remains debated whether the disease is progressive, treatment in an early stage is recommendable as it carries less risk for ovarian damage, hence premature ovarian failure. Under water, inspection with the technique of transvaginal hydrolaparoscopy (THL) accurately shows the invagination of the ovarian cortex as minimal superficial lesions but with the presence of well-differentiated endometrial like tissue at the base, the lateral walls and especially the inner edges of the small endometrioma. An inflammatory environment is responsible for the formation of connecting adhesions with the broad ligament and lateral wall with invasion of endometrial-like tissue and formation of adenomyotic lesions. In around 50 % of the small endometriomas, adhesiolysis is necessary at the site of invagination with opening of the cyst, to free the chocolate content and hereby recognize the underlying endometrioma. The detailed inspection of these early-stage endometriotic lesions at THL reunites the hypothesis of Sampson with the observation of Hughesdon.
KEYWORDS:
Endometrioma, Endoscopy, Hydroflotation, Ovarian endometriosis, Pathogenesis, Surgery, Transvaginal hydrolaparoscopy
- PMID:
- 24611037
- [PubMed]
Saturday, March 01, 2014
Abdominal cocoon: an unusual cause of subacute intestinal obstruction.
Indian J Surg. 2013 Jun;75(Suppl 1):391-3. doi: 10.1007/s12262-012-0582-9. Epub 2012 Sep 1.
Abdominal cocoon: an unusual cause of subacute intestinal obstruction.
Abstract
We report an unusual cause of subacute intestinal obstruction in a young adolescent girl, which is a nontubercular abdominal cocoon. Barium meal follow-through revealed "cauliflower"-like appearance of small bowel. The patient underwent an exploratory laparotomy showing thick fibrous-like coverings which were encasing the small bowel loops to form an abdominal cocoon. Fibrocollagenous membrane was excised after adhesiolysis. Histopathological examination of membrane revealed fibrocollagenous membrane with hyaline deposition of nontubercular origin.
KEYWORDS:
Abdominal cocoon, Sclerosing encapsulating peritonitis, Subacute intestinal obstruction
- PMID:
- 24426626
- [PubMed]
- PMCID:
- PMC3693371
- [Available on 2014/6/1]
Sunday, December 22, 2013
The inpatient burden of abdominal and gynecological adhesiolysis in the US w Thanks to NIH
BMC Surg. 2011; 11: 13.
Published online 2011 June 9. doi: 10.1186/1471-2482-11-13
PMCID: PMC3141363
The inpatient burden of abdominal and gynecological adhesiolysis in the US
This article has been cited by other articles in PMC.
Background
Adhesions are fibrous bands of scar tissue, often result of surgery, that form between internal organs and tissues, joining them together abnormally [1]. 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 [2].
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 [5]. 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 [2]. 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 [2]. This cost has decreased when compared with similar data from 1988,[10] 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 [2].
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.
Methods
Data Source
Data were taken from the 2005 Healthcare Cost and Utilization Project's (HCUP) Nationwide Inpatient Sample (NIS)[11]. 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 [12]. 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 [13].
RTI International's Institutional Review Board determined that this study met all criteria for exemption.
Study Sample
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
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 [2]. 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 [2]. 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.
Statistical Analyses
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 [10] to 117.3 in 1994 [2] 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 [2]. Although laparoscopy reduces surgical trauma, the procedure has not been show to reduce the incidence of adhesion-related readmissions [16].
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 [17]. 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.
Conclusions
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.
Competing interests
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.
Authors' contributions
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.
Funding
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.
Pre-publication history
The pre-publication history for this paper can be accessed here:
Acknowledgements
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.
References
- 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
Subscribe to:
Posts (Atom)