Patient Sequelae and Accrued Health Care Costs from Intra-Abdominal/Pelvic Adhesions
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Objective: The purpose of this study was to review and compile the latest published data on the subject of postoperative peritoneal adhesions specific to the obstetric and gynecologic population, and examine its associated economic implications. Materials and Methods: This is a review of the published literature to identify studies on adhesions in obstetrics and gynecology that reported any of four outcomes of interest (hospital readmission [medical/surgical], small bowel obstruction, operating room time costs, and impact on subsequent surgical intervention). PubMed database was scanned for English-language references published between January 1995 and January 2011. Search terms included: peritoneal adhesions after gynecologic surgery, peritoneal adhesions after obstetric surgery, and cost analysis of peritoneal adhesions. Articles, conference abstracts, and professional medical society consensus statements were reviewed. References pertaining to the pediatric population (≤14 years of age), non-abdominal/pelvic location, or those discussing only molecular/pathophysiological adhesion development were excluded. Also excluded were publications relating to infertility or chronic pelvic pain, for a more detailed compilation relating to our four main categories. Results: A total of 122 PubMed materials were identified using the initial search strategy: "peritoneal adhesions after gynecologic surgery" n=86, "peritoneal adhesions after obstetric surgery" n=25, and "cost analysis of peritoneal adhesions" n=11. Conclusions: With the review of the current focused data, the importance of peritoneal adhesion prevention and future research is evident. At a time when the United States cesarean delivery rate approaches 1 of every 3 pregnancies, we must continually strive to reduce patient morbidity. © 2012 Mary Ann Liebert, Inc.
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