FPA Women's Health, Medical Director, 2777 Long Beach Blvd, Long Beach, CA 90806.
Bayer U.S. LLC., 100 Bayer Blvd, Whippany, NJ 07981.
Contraception. 2018 May;97(5):428-433. doi: 10.1016/j.contraception.2017.12.015. Epub 2017 Dec 27.
The objectives were to compare the long-term outcomes, including hysterectomy, chronic pelvic pain (CPP) and abnormal uterine bleeding (AUB), in women post hysteroscopic sterilization (HS) and laparoscopic tubal ligation (TL) in the Medicaid population.
This was a retrospective observational cohort analysis using data from the US Medicaid Analytic Extracts Encounters database. Women aged 18 to 49years with at least one claim for HS (n=3929) or TL (n=10,875) between July 1, 2009, through December 31, 2010, were included. Main outcome measures were hysterectomy, CPP or AUB in the 24months poststerilization. Propensity score matching was used to control for patient demographics and baseline characteristics. Logistic regression analysis investigated the variables associated with a 24-month rate of each outcome in the HS versus laparoscopic TL cohorts.
Postmatching analyses were performed at 6, 12 and 24months post index procedure. At 24months, hysterectomy was more common in the laparoscopic TL than the HS group (3.5% vs. 2.1%; p=.0023), as was diagnosis of CPP (26.8% vs. 23.5%; p=.0050). No significant differences in AUB diagnoses were observed. Logistic regression identified HS as being associated with lower risk of hysterectomy (odds ratio [OR] 0.77 [95% confidence interval {CI} 0.60-0.97]; p=.0274) and lower risk of CPP diagnosis (OR 0.91 [95% CI 0.83-0.99]; p=.0336) at 24months poststerilization.
In Medicaid patients, HS is associated with a significantly lower risk of hysterectomy or CPP diagnosis 24months poststerilization versus laparoscopic TL. Incidence of AUB poststerilization is not significantly different. While some differences in outcomes were statistically significant, the effect sizes were small, and the conclusion is one of equivalence and not clinical superiority.
This propensity score matching analysis confirms that pelvic pain and AUB are common in women before and after sterilization regardless of whether the procedure is performed hysteroscopically or laparoscopically. Moreover, HS is associated with a significantly lower risk of hysterectomy or a CPP diagnosis in the 24months poststerilization when compared to TL.
比较接受宫腔镜绝育（HS）和腹腔镜输卵管结扎（TL）的女性在 Medicaid 人群中的长期结局，包括子宫切除术、慢性盆腔痛（CPP）和异常子宫出血（AUB）。
这是一项使用美国 Medicaid 分析提取记录数据库数据的回顾性观察队列分析。2009 年 7 月 1 日至 2010 年 12 月 31 日期间，年龄在 18 至 49 岁之间、至少有一次 HS（n=3929）或 TL（n=10875）索赔的女性被纳入研究。主要结局指标是绝育后 24 个月内的子宫切除术、CPP 或 AUB。采用倾向评分匹配来控制患者人口统计学和基线特征。逻辑回归分析调查了与 HS 与腹腔镜 TL 队列 24 个月内每种结局发生率相关的变量。
在指数手术后 6、12 和 24 个月进行了匹配后分析。在 24 个月时，TL 组的子宫切除术发生率高于 HS 组（3.5%比 2.1%；p=.0023），CPP 诊断率也高于 HS 组（26.8%比 23.5%；p=.0050）。AUB 诊断率无显著差异。逻辑回归确定 HS 与子宫切除术风险降低相关（优势比[OR]0.77[95%置信区间{CI}0.60-0.97]；p=.0274）和 CPP 诊断风险降低相关（OR 0.91[95% CI 0.83-0.99]；p=.0336）。
在 Medicaid 患者中，HS 与绝育后 24 个月内子宫切除术或 CPP 诊断风险显著降低相关，而绝育后 AUB 的发生率无显著差异。尽管一些结局的差异具有统计学意义，但效应大小较小，结论是等效的，而不是临床优越性。
这项倾向评分匹配分析证实，无论手术是经宫腔镜还是腹腔镜进行，盆腔痛和 AUB 在绝育前和绝育后都是常见的。此外，与 TL 相比，HS 与绝育后 24 个月内子宫切除术或 CPP 诊断风险显著降低相关。
