Conover Mitchell M, Howell Jennifer O, Wu Jennifer M, Kinlaw Alan C, Dasgupta Nabarun, Jonsson Funk Michele
Center for Women's Health Research, University of North Carolina at Chapel Hill, 104B Market Street, Chapel Hill, NC, 27704, USA.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599-7400, USA.
Pharmacoepidemiol Drug Saf. 2015 Aug;24(8):875-84. doi: 10.1002/pds.3766. Epub 2015 Mar 31.
Compare incidence of opioid-managed pelvic pain within 12 months after hysteroscopic and laparoscopic sterilization.
Using administrative claims, we identified women aged 18-49 years without recent history of childbirth who underwent hysteroscopic or laparoscopic sterilization between 2005 and 2012. We defined the outcome as ≥2 diagnoses for pelvic pain and ≥2 prescription fills for opioids. We calculated adjusted hazard ratios (HR) using Cox models and propensity score methods (matching and inverse-probability-of-treatment-weighting [IPTW]).
We identified 71,875 eligible women (hysteroscopic n = 26,927 [37.5%], laparoscopic n = 44,948 [62.5%]). Of those, 236 (0.88%) hysteroscopic patients and 420 (0.93%) laparoscopic patients experienced the outcome (crude HR = 0.97, 95%CI: [0.83, 1.14]). Adjusted analyses also yielded near-null results (matched HR = 1.08, 95%CI [0.90, 1.31]; IPTW HR = 0.97, 95%CI [0.80, 1.18]). While most sensitivity analyses generated results close to the null, hazard ratios estimated using propensity score matching ranged from 0.65 to 1.53.
Among women without recent history of childbirth, we did not find compelling evidence of a clinically meaningful increase in the incidence of pelvic pain requiring opioids during the year after hysteroscopic sterilization. However, effects observed in sensitivity analyses may merit further investigation.
比较宫腔镜绝育术和腹腔镜绝育术后12个月内阿片类药物治疗盆腔疼痛的发生率。
利用行政索赔数据，我们确定了年龄在18 - 49岁之间、近期无分娩史且在2005年至2012年间接受宫腔镜或腹腔镜绝育术的女性。我们将结局定义为盆腔疼痛诊断≥2次且阿片类药物处方≥2次。我们使用Cox模型和倾向评分方法（匹配和逆概率治疗加权法[IPTW]）计算调整后的风险比（HR）。
我们确定了7l,875名符合条件的女性（宫腔镜组n = 26,927 [37.5%]，腹腔镜组n = 44,948 [62.5%]）。其中，236名（0.88%）宫腔镜手术患者和420名（0.93%）腹腔镜手术患者出现了该结局（粗HR = 0.97, 95%CI: [0.83, 1.14]）。调整分析也得出了接近无效的结果（匹配HR = 1.08, 95%CI [0.90, 1.31]；IPTW HR = 0.97, 95%CI [0.80, 1.18]）。虽然大多数敏感性分析得出的结果接近无效，但使用倾向评分匹配估计的风险比范围为0.65至1.53。
在近期无分娩史的女性中，我们没有发现令人信服的证据表明宫腔镜绝育术后一年内需要使用阿片类药物治疗的盆腔疼痛发生率有临床意义的增加。然而，敏感性分析中观察到的影响可能值得进一步研究。
