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

On Hasenbergstraße 46 
41462 Neuss 
North Rhine-Westphalia
Germany

Phone : 02131/5295-5002 
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

Phone : 02841/107-2430 
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. 

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

Burden of adhesions in abdominal and pelvic surgery: systematic review and met-analysis

Maryland follows New Jersey in Seprafilm Suit

AG Gansler: Genzyme Corp. Pays $22.28 Million for Fraudulent Marketing of ' Slurry' Improperly Used in Surgery Maryland Medicaid to receive $85,000 from Seprafilm allegations

AG Gansler: Genzyme Corp. Pays 22.28 Million for Fraudulent Marketing of ' Slurry' Improperly Used in Surgery Maryland Medicaid to receive 85,000 from Seprafilm allegations

Mar 10, 2014 (Menafn - M2 PRESSWIRE via COMTEX) --Attorney General Douglas F. Gansler announced today that Maryland, joined by other states and the federal government, has secured a settlement resolving allegations that Genzyme Corporation triggered false claims to be submitted to federal and state health care programs for unapproved use of a "slurry" version of its Seprafilm adhesion barrier. Genzyme will pay 22.28 million under the settlement. Maryland Medicaid will receive 84,627.69, to be shared with the federal government, which provides funding for the program.

"Cutting corners shows little concern for the wellbeing of the people who used this product and for the general public whose tax dollars support the Medicaid program," said Attorney General Gansler. "The profit from the fraudulent sales of this product will be forfeited and returned to its intended use."

Seprafilm is intended to reduce post-surgical adhesions by forming a bio-resorbable (broken down and assimilated back into the body) barrier between abdominal tissue and organs. This Food and Drug Administration (FDA)-approved product is for use in open abdominal surgery, but not for minimally invasive procedures such as laparoscopic surgery.

The settlement resolves allegations that Genzyme sales representatives taught doctors and other staff to cut the Seprafilm sheets into small pieces, add saline and allow the pieces to dissolve until the desired consistency was reached. This mixture was referred to as "slurry." Genzyme sales representatives traded recipes for slurry and trained each other how to produce it. The slurry was used in laparoscopic surgeries by inserting a catheter filled with the mixture into the body and applying it into the abdominal cavity. As a result of this conduct, Genzyme knowingly caused hospitals and other purchasers of Seprafilm to submit false and fraudulent claims to federal health care programs for uses that were not FDA-approved and therefore, not reimbursable.

Genzyme is a biotechnology corporation based in Cambridge, Mass., and was acquired by Sanofi-Aventis SA in April 2011.

Attorney General Gansler thanked Medicaid Fraud Control Unit Deputy Director Shelly Marie Martin for her work on this case. A National Association of Medicaid Fraud Control Units (NAMFCU) team participated in the investigation and conducted settlement negotiations with Genzyme.

Attorney General of Maryland 1 (888) 743-0023 toll-free / TDD: (410) 576-6372

((M2 Communications disclaims all liability for information provided within M2 PressWIRE. Data supplied by named party/parties. Further information on M2 PressWIRE can be obtained at http://www.presswire.com on the world wide web. Inquiries to info@m2.com.

(C)1994-2014 M2 COMMUNICATIONS

CollaGUARD adhesion barrier now in distributed in UK and Germany

01 Feb, 2012

Innocoll Enters CollaGUARD® Distribution Partnership with Flynn Pharma Ltd in the UK and Inresa Arzneimittel GmbH in Germany

ASHBURN, VA., February 1, 2012 /PRNewswire/ –– Innocoll Inc. announced it has entered into a License and Distribution Agreement with Flynn Pharma Ltd. in the United Kingdom and with Inresa Arzneimittel GmbH in Germany for CollaGUARD surgical adhesion barrier for the prevention of postoperative adhesions following abdominal and pelvic surgery.

[More]

Should women with chronic pelvic pain have adhesiolysis?

Pelvic adhesions are found in up to 50% of women with CPP during investigative surgeries and adhesiolysis is often performed as part of their management although the causal or casual association of adhesions, and the clinical benefit of adhesiolysis in the context of CPP is still unclear. Our aim was to test the hypothesis of whether laparoscopic adhesiolysis leads to significant pain relief and improvement in quality of life (QoL) in patients with chronic pelvic pain (CPP) and adhesions. 

Methods: This was a double-blinded RCT.

This study was conducted in 2 tertiary referral hospitals in United Kingdom over 4 years. Women with chronic pelvic pain (CPP) were randomized into having laparoscopic adhesiolysis or diagnostic laparoscopy.

Women were assessed at 0, 3 and 6 months for Visual analogue scale scores (VAS) and Quality of Life (QoL) measures (SF-12 and EHP-30). 

Results: A total of 92 participants were recruited; 50 qualified to be randomized, with 26 in the adhesiolysis and 24 in the control group. The results are expressed in median (interquartile ranges).

In women who underwent adhesiolysis, there was a significant improvement at 6 months in VAS scores (-17.5 (-36.0 - -5.0) compared to controls (-1.5 (-15.0 - 4.5; p = 0.048); SF-12 scores physical component score (25.0 (18.8 - 43.8)) compared to controls (6.3 (-6.3 - 18.8); p = 0.021), SF-12 emotional component score 32.5 (4.4 - 48.8) compared to controls -5 (-21.3 - 15.0); p <0 -5="" -="" .0074="" 15.0="" 32.5="" 48.8="" and="" being="" compared="" controls="" domain="" ehp-30="" emotional="" nbsp="" p="" span="" the="" to="" well="">

Conclusions: This study stopped before recruitment reached the statistically powered sample size due to difficulty with enrollment and lack of continued funding. In selected population of women presenting to the gynecological clinic with chronic pelvic pain, adhesiolysis in those who have adhesions may be of benefit in terms of improvement of pain and their quality of life.Trial registration number: ISRCTN 43852269 http://www.controlled-trials.com/isrctn/pf/43852269

Author: Ying C CheongIsobel ReadingSarah BaileyKhaled SadekWilliam LedgerTin C Li
Credits/Source: BMC Women's Health 2014, 14:36

http://7thspace.com/headlines/453858/should_women_with_chronic_pelvic_pain_have_adhesiolysis.html

Men get adhesions

Do Men Get Adhesions? 

 

David Wiseman PhD, MRPharmS, Founder, International Adhesions Society 

 

It is a common myth that only women are prone to adhesions. While it is 

certainly true that women have more “internal parts” that require surgery, which 

inevitably leads to adhesions, men are not excluded from the problem of 

adhesions. 

 

A simple look at the national statistics collected from hospital discharges (ICD9 

codes) from the most recent data available (2001-2005) reveals the following: 

 

• Over 50,000 men were discharged from hospital in 2005 with a diagnosis 

of peritoneal adhesions (568.0), accounting for 28% of such diagnoses, 

compared with 72% for women. 

• Over 37,000 men were discharged in 2005 with a diagnosis that included 

the specific diagnosis of intestinal adhesions with (ie causing) bowel 

obstruction (560.81). This number accounts for 38% of cases, compared 

with 62% for women. 

• Men also accounted for 37% of discharges with a principal diagnosis (as 

opposed to an incidental diagnosis) was intestinal adhesions with 

obstruction (560.81). Their length of stay was slightly higher than that of 

women in 3 of the five years studied and their hospital charges exceeded 

those of women in every year by as much as $2500. 

• Over 2000 men and women died every year with a diagnosis of intestinal 

adhesions with obstruction, representing about 3% of the total discharges 

with that diagnosis. The contribution of males to this death rate was in 

every year slightly higher than that of women in proportion to their 

discharges, by 10-15% in the years 2002-2005, and about 2% in 2001. 

 

Overall discharges for men and women have been climbing at the same rate over 

the five year period studied. 

More of this article http://www.adhesionrelateddisorder.com/DoMenGetAdhesions.pdf

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.

Shah MY1, Gedam BS2, Sonarkar R3, Gopinath KS4.

Author information

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

http://www.ncbi.nlm.nih.gov/pubmed/24426626

PMID:

 

24426626

 

[PubMed] 

PMCID:

 

PMC3693371

 [Available on 2014/6/1]

Abdominal Wall Lift ~ Beware the Abdolift

Beware of the Abdo-lift....

Abdominal wall lift decreases cardiopulmonary changes, does not influence the morbidity and, increases operating time in laparoscopic cholecystectomy. It cannot be recommended routinely
.Gurusamy KS, Samraj K, Davidson BR.Published Online: July 16, 2008.Several physiological parameters related to heart and lung (cardiopulmonary changes) occur during insufflation of abdomen (tummy) with key-hole surgery. While these changes can be tolerated by normal individuals, patients with poor heart or lung function may not tolerate the changes. These changes in physiological parameters related to heart and lung are decreased by using special instruments to lift the front wall of the abdomen so that key-hole surgery can be performed without gas insufflation. In this systematic review of 20 trials including 706 patients (six trials including 156 patients used gas at very low pressures), it is shown that the technique of lifting the front wall of the tummy is associated with increased operating time (8 minutes) without reducing surgical complications. It cannot be recommended as a routine in patients with mild or no systemic disease. So, it cannot be recommended routinely in patients with low anaesthetic risk.
http://summaries.cochrane.org/CD006574/abdominal-wall-lift-decreases-cardiopulmonary-changes-does-not-influence-the-morbidity-and-increases-operating-time-in-laparoscopic-cholecystectomy.-it-cannot-be-recommended-routinely

Where are Kruschinski's studies? Oh right there aren't any real ones, just vividly imagined ones.

Hutter Finally Rids himself of Kruschinski at Klinik am Zuckerberg

All signs of Kruschinski's existence has been eradicated from the Zuckerberg website....go see for yourself.

We are actually grateful as adhesion patients were having major abdominal surgeries at a day surgery plastic surgery type clinic..exceedingly dangerous 
...perhaps you will be safer at Herzog but with Kru and his evil hook....we doubt it.
Hutter has hidden him here.
http://www.herzog-karl-klinik.de/gynaekologie/index.htm 

Clinic after clinic after clinic.

Kruschinski Steward Adhesion Whoppers

Found on a fundraising site for a poor young woman stricken with adhesion's. Poor dear thinks she needs $20 grand in cash to not die!

"Surgeons in the USA have only a 10% success rate. It's that bad because the F.D.A. has been dragging there feet in approving the materiel that has been successfully working for 13 years worth of surgeries in other parts of the world.

The doctor that I need to see is in Germany and he has a 95% success rate with adhesion surgery."

All of the above is stated to lure you to an all cash surgery IN GERMANY with Daniel Kruschinski. Con man extraordinaire. 

THESES PEOPLE PREY ON THE MOST VULNERABLE PATIENT POPULATION EVER.
They will say anything to get you on that shoddy bandwagon.

The statements above don't have one grain of truth in them...not one. Go ahead and see if you can find any studies that state these luring proclamations.
Do you homework and verify all information yourself. We know you are sick but this is your life. There is help, there is hope and very close to where ever you live. Don't trust another to do your footwork for you ( Like Karen )

Hernia and Adhesions Q&A from The Surgeons Lounge

"The patient presented to our clinic with complaints of nausea, vomiting and abdominal pain. The nausea and vomiting started in January 2012, a few months after the small bowel resection. It was noted that he was not able to tolerate a regular diet after surgery for an extended period of time. His physician prescribed metoclopramide without effect, and the nausea occurred three to four times weekly with vomiting at least once or twice per week. Eating sometimes exacerbated the nausea and vomiting. He also complained of intermittent bloating and abdominal distention."
Read the full question in full with answer and scans too...
http://www.generalsurgerynews.com/ViewArticle.aspx?d=The%2BSurgeon%27s%2BLounge&d_id=72&i=January+2014&i_id=1032&a_id=24814

Teenager speaks out over medical condition that leaves her looking nine months pregnant every time she eats

Hey, wait a minute! 
RACHEL Harley, 19, had to turn down a place at University in London because of her health after developing a bizarre condition that makes her stomach swell so much after eating that people think she's expecting.
http://www.dailyrecord.co.uk/news/real-life/teenager-speaks-out-over-medical-2880437
Teenager speaks out over medical condition that leaves her looking nine months pregnant every time she eats

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

Vanja Sikirica,1 Bela Bapat,2 Sean D Candrilli,2 Keith L Davis,2 Malcolm Wilson,3 and Alan Johns4

Author information ► Article notes ► Copyright and License information ►

This article has been cited by other articles in PMC.

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Abstract

Background

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]).

Methods

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.

Results

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.

Conclusions

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

Go to:

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.

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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:

Table 1

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.

Table 2

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

Descriptive analyses were conducted to display the mean, standard deviation, median, and range of continuous variables, as well as the frequency distribution of categorical variables. All data management and analyses were conducted with SAS and SUDAAN statistical software packages [14,15].

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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).

Table 3

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.

Table 4

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.

Table 5

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.

Table 6

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.

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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.

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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.

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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.

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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.

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Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-2482/11/13/prepub

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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.

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Articles from BMC Surgery are provided here courtesy of BioMed Central

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3141363/