Adhesion Barrier Use After Myomectomy and Hysterectomy: Rates and Immediate Postoperative Complications.

Abstract

To evaluate use rates and immediate postoperative complications of the use of an adhesion barrier in myomectomy or hysterectomy. 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. 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. 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.