Utilization and safety of sodium hyaluronate- Carboxymethylcellulose adhesion barrier

Shazia Bashir, Cande V. Ananth, Sharyn N. Lewin, William M. Burke, Yu Shiang Lu, Alfred I. Neugut, Thomas J. Herzog, Dawn L. Hershman, Jason D. Wright

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


Background: Little is known about the use and toxicity of antiadhesion substances such as sodium hyaluronatecarboxymethylcellulose. Objective: We analyzed the patterns of use and safety of sodium hyaluronate- carboxymethylcellulose in patients undergoing colectomy and gynecologic surgery. DESIGN: This is a retrospective cohort study. SETTING: This study covered hospitals nationwide. PATIENTS: All patients in the Premier Perspective database who underwent colectomy or hysterectomy from 2000 to 2010 were included in the analyses. MAIN OUTCOME MEASURE: Hyaluronatecarboxymethylcellulose 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 hyaluronatecarboxymethylcellulose, whereas a propensity scorematched analysis was used to secondarily assess the association between hyaluronate-carboxymethylcellulose use and toxicity (abscess, bowel and wound complications, peritonitis). Results: 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 hyaluronatecarboxymethylcellulose 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. LIMITATIONS: This was an observational study. CONCLUSION: 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, hyaluronatecarboxymethylcellulose use was associated with a small increased risk of abscess after colectomy.

Original languageEnglish
Pages (from-to)1174-1184
Number of pages11
JournalDiseases of the Colon and Rectum
Issue number10
StatePublished - Oct 2013
Externally publishedYes


  • Adhesion
  • Colectomy.
  • Hyaluronate-carboxymethylcellulose
  • Hyaluronic acid/carboxymethyl cellulose membrane
  • Hysterectomy


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