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Seven-Year Outcomes After Hysteroscopic and Laparoscopic Sterilizations

Mao, Jialin MD, MSc; Guiahi, Maryam MD, MSc; Chudnoff, Scott MD; Schlegel, Peter MD; Pfeifer, Samantha MD; Sedrakyan, Art MD, PhD

doi: 10.1097/AOG.0000000000003092
Contents: Contraception: Original Research
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OBJECTIVE: To evaluate 7-year outcomes after hysteroscopic and laparoscopic sterilizations, including subsequent tubal interventions and hysterectomies.

METHODS: This observational cohort study included women undergoing hysteroscopic and laparoscopic sterilizations in outpatient and ambulatory surgical settings in New York State during 2005–2016. We examined subsequent procedures (tubal ligation or resection, and hysterectomy not related to uterine leiomyomas or gynecologic tumors) after the index procedures. After propensity score matching, we used Kaplan-Meier analysis to obtain estimated risks of subsequent procedures within 7 years of index sterilization procedures, and Cox proportional hazard models to compare the differences between groups.

RESULTS: We identified 10,143 and 53,206 women who underwent interval hysteroscopic and laparoscopic sterilizations, respectively, in New York State during 2005–2016. The mean age of the cohort was 34.2 years (range 18–80). The propensity score–matched cohort consisted of 10,109 pairs of women. The estimated risk of undergoing an additional tubal ligation or resection within 7 years was higher after hysteroscopic sterilization than it was after laparoscopic sterilization (3.9% vs 1.6%, HR 2.89, 95% CI 2.33–3.57). The difference was most pronounced within the initial year after attempted sterilization (1.5% vs 0.2%; HR 6.39, 95% CI 4.16–9.80). There was no significant difference in the risk of receiving a hysterectomy (0.9% vs 1.2%; HR 0.73, 95% CI 0.53–1.00) between women who underwent hysteroscopic and laparoscopic sterilizations.

CONCLUSION: Patients undergoing hysteroscopic sterilization have a higher risk of receiving an additional tubal resection or ligation than those undergoing laparoscopic sterilization, particularly within the first year of the index procedure. There is no difference in undergoing a subsequent hysterectomy between the two groups. With limited evidence of outcomes after hysteroscopic sterilization beyond 7 years and existing reports of removals years after initial implantations, continuous monitoring of long-term outcomes for women who received the device is warranted.

Patients undergoing hysteroscopic sterilization have a higher risk of subsequent tubal resections or ligations than those undergoing laparoscopic sterilization, particularly within the first year.

Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York; the Department of Obstetrics and Gynecology, Division of Family Planning, University of Colorado Anschutz Medical Campus, Aurora, Colorado; the Department of Obstetrics and Gynecology, Stamford Hospital, Stamford, Connecticut; and the Departments of Urology and Obstetrics and Gynecology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.

Corresponding author: Jialin Mao, MD, MSc, Instructor of Healthcare Policy and Research, Weill Cornell Medical College, 402 E 67th St, New York, NY 10065; email: jim2012@med.cornell.edu.

Supported in part by the U.S. Food and Drug Administration [Grant number U01FD005478]. Maryam Guiahi's time was supported by the Society of Family Planning Junior Investigator Career Grant SFPRF10-JI1.

Financial Disclosure The University of Colorado Department of Obstetrics and Gynecology has received research funding from Bayer, Agile Therapeutics, Merck and Co, and Medicines360. The other authors did not report any potential conflicts of interest.

Presented at the Women's Health Technology CRN Annual Meeting, September 7, 2018, Silver Spring, Maryland.

Each author has confirmed compliance with the journal's requirements for authorship.

Peer reviews and author correspondence are available at http://links.lww.com/AOG/B251.

© 2019 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.