Adhesion barriers and intraperitoneal or uterine infections after cesarean section: A retrospective cohort study

Wada, Yoshimitsu; Takahashi, Hironori; Matsui, Hiroki; Yasunaga, Hideo; Fujiwara, Hiroyuki; Sasabuchi, Yusuke

doi:10.1016/j.surg.2022.08.029

Cited by 6 publications

(1 citation statement)

References 19 publications

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“…We conducted this retrospective cohort study by using the data from an administrative database of 18 of 25 districts in Tochigi Prefecture, a northern prefecture of the Greater Tokyo Area. 16 The database contains claims of two medical insurances and a long-term care insurance of approximately 1,300,000 residents, representing approximately 60% of residents in the prefecture. The two types of medical insurances were National Health Insurance (for self-employed individuals, retired individuals, and their dependents) and Late Elders’ Health Insurance (for all people aged ≥ 75 years of age).…”

Section: Methodsmentioning

confidence: 99%

Long-Term Risk of Being Bedridden in Elderly Patients Who Underwent Oncologic Surgery: A Retrospective Study Using a Japanese Claims Database

et al. 2023

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Background Although functional outcomes are important in surgery for elderly patients, the long-term functional prognosis following oncologic surgery is unclear. We retrospectively investigated the long-term, functional and survival prognosis following major oncologic surgery according to age among elderly patients. Methods We used a Japanese administrative database to identify 11,896 patients aged ≥ 65 years who underwent major oncological surgery between June 2014 and February 2019. We investigated the association between age at surgery and the postoperative incidence of bedridden status and mortality. Using the Fine–Gray model and restricted cubic spline functions, we conducted a multivariable, survival analysis with adjustments for patient background characteristics and treatment courses to estimate hazard ratios for the outcomes. Results During a median follow-up of 588 (interquartile range, 267–997) days, 657 patients (5.5%) became bedridden and 1540 (13%) died. Patients aged ≥ 70 years had a significantly higher incidence of being bedridden than those aged 65–69 years; the subdistribution hazard ratios of the age groups of 70–74, 75–79, 80–84, and ≥ 85 years were 3.20 (95% confidence interval [CI], 1.53–6.71), 3.86 (95% CI 1.89–7.89), 6.26 (95% CI 3.06–12.8), and 8.60 (95% CI 4.19–17.7), respectively. Restricted cubic spline analysis demonstrated an increase in the incidence of bedridden status in patients aged ≥ 65 years, whereas mortality increased in patients aged ≥ 75 years. Conclusions This large-scale, observational study revealed that older age at oncological surgery was associated with poorer functional outcomes and higher mortality among patients aged ≥ 65 years.

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Section: Methodsmentioning

confidence: 99%

Long-Term Risk of Being Bedridden in Elderly Patients Who Underwent Oncologic Surgery: A Retrospective Study Using a Japanese Claims Database

et al. 2023

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Risk factors for relaparotomy after cesarean delivery

Hendin,

Seidman,

Geron

et al. 2024

Intl J Gynecology & Obste

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ObjectiveTo identify and analyze risk factors associated with relaparotomy following cesarean delivery (CD), focusing on obstetric and surgical parameters.MethodsRetrospective case–control study conducted at a high‐volume tertiary obstetric center. We reviewed all women who underwent CD between 2013 and 2023. Patients who required a relaparotomy, defined as the reopening of the fascia, were included in the study group. Patient data were systematically reviewed to identify potential risk factors contributing to the need for post‐CD relaparotomy, compared with a control group that did not undergo a relaparotomy.ResultsOut of 11 465 women underwent CD, 59 (0.5%) required relaparotomy. Using a multivariate model for independent risk factors, we found the following to be associated with relaparotomy: emergency CD (adjusted odds ratio [aOR] 3.09, 95% confidence interval [CI] 1.78–5.38, P < 0.01), placenta previa (aOR 4.66, 95% CI 1.54–14.11, P < 0.01), and multiple gestation as indications for the CD (aOR 4.61, 95% CI 2.10–10.12, P < 0.01); estimated intraoperative blood loss of more than 1 L (aOR 5.98, 95% CI 2.79–12.80, P < 0.01); and intraoperative adhesions (aOR 7.12, 95% CI 4.06–12.48, P < 0.01).ConclusionsOur study underscores the multifactorial nature of relaparotomy after CD, emphasizing the significance of considering a broad array of risk factors. By identifying and understanding these factors, clinicians can optimize patient care and potentially reduce morbidity, particularly the need for subsequent surgical interventions.

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Dual‐Polymer Carboxymethyl Cellulose and Poly(Ethylene Oxide)‐Based Gels for the Prevention of Postsurgical Adhesions

DSouza,

Amiji

2024

J Biomedical Materials Res

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Postsurgical adhesions are a common complication associated with surgical procedures; they not only impact the patient's well‐being but also impose a financial burden due to medical expenses required for reoperative surgeries or adhesiolysis. Adhesions can range from a filmy, fibrinous, or fibrous vascular band to a cohesive attachment, and they can form in diverse anatomical locations such as the peritoneum, pericardium, endometrium, tendons, synovium, and epidural and pleural spaces. Numerous strategies have been explored to minimize the occurrence of postsurgical adhesions. These strategies include surgical approaches, adhesiolysis, antiadhesive agents, and mechanical barriers which have demonstrated the most promise in terms of efficacy and breadth of indications. In this review, we discuss the use of physical/mechanical barriers for adhesion prevention and outline the most commonly used, commercially available barriers. We then focus on a synthetic, dual‐polymer gel composed of carboxymethyl cellulose (CMC) and poly(ethylene oxide) [PEO], which, unlike the more commonly used single‐polymer hydrogels, has demonstrated higher efficacy across a greater range of indications and surgical procedures. We review the formulation, mechanical properties, and mechanisms of action of the CMC + PEO dual‐polymer gel and summarize findings from clinical studies that have assessed the efficacy of CMC + PEO gels in multiple surgical settings in clinics across the world. In conclusion, the CMC + PEO dual‐polymer gel represents an approach to preventing postsurgical adhesions that has been commonly used over the last 20 years and could therefore serve as a foundation for research into improving postsurgical outcomes as well as a drug delivery device to expand the use of gels in surgical settings.

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Adhesion barriers and intraperitoneal or uterine infections after cesarean section: A retrospective cohort study

Cited by 6 publications

References 19 publications

Long-Term Risk of Being Bedridden in Elderly Patients Who Underwent Oncologic Surgery: A Retrospective Study Using a Japanese Claims Database

Long-Term Risk of Being Bedridden in Elderly Patients Who Underwent Oncologic Surgery: A Retrospective Study Using a Japanese Claims Database

Risk factors for relaparotomy after cesarean delivery

Dual‐Polymer Carboxymethyl Cellulose and Poly(Ethylene Oxide)‐Based Gels for the Prevention of Postsurgical Adhesions

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