Katabi Leila, Stevens Erica, Ascha Mona, Arora Kavita
Case Western Reserve University School of Medicine, Cleveland, OH, 44106, USA.
Division of Plastic and Reconstructive Surgery, Department of Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, 44106, USA.
Open Access J Contracept. 2022 Aug 8;13:111-119. doi: 10.2147/OAJC.S368250. eCollection 2022.
Etonogestrel subdermal implants are a commonly used contraceptive device placed in the medial upper arm. Plastic and orthopedic surgeons may be consulted for difficult implant removals. We performed a case-control study comparing patients undergoing surgical and uncomplicated in-office removal at our institution.
We identified patients who underwent operative removal of implantable contraceptive devices by plastic or orthopedic surgeons at our institution from January 2014 to October 2019. Patients who underwent uncomplicated office removal during the same time were compared. Demographic and surgical variables were collected, and descriptive statistics were calculated. Univariate and multivariate logistic regression was performed with surgical versus outpatient removal as the outcome of interest.
A total of 669 patients undergoing etonogestrel subdermal implant removals were identified during the five-year study period, of which thirteen patients required surgical removal (1.9%) and 326 were selected as uncomplicated removal comparisons. There were no significant differences in median (IQR) body mass index (BMI) (31.1 [28.2, 35.2] versus 29.3 [24.0, 35.1], p = 0.19), median (IQR) weight gain since device placement (5 [-0.6, 14.7] kilograms versus 1.6 [-1.2, 5.8] kilograms, p = 0.15), or length of time since device insertion (2.3 [0.8, 2.8] years versus 1.0 [0.4, 2.2] years, p = 0.17). Of those who needed surgical removal, the most common indication for implant removal was device expiration (n = 5, 38.5%). Devices placed by OBGYN attendings were less likely to require surgical removal (p = 0.02). Family medicine attendings were more likely to refer patients for surgical removal (p = 0.02). No significant findings were detected on univariate or multivariate regression. Among surgical removals, radiography was the most frequently used imaging modality. Implants were most frequently subdermal (n = 11, 84.6%) though intramuscular placement was also identified (n = 2, 15.4%). Only one patient had residual paresthesia along the length of the incision. No other complications were identified.
We did not identify risk factors associated with the difficult removal of etonogestrel subdermal implants. Practitioners should consult upper extremity surgeons if they encounter difficult removals.
依托孕烯皮下植入剂是一种常用的避孕装置，置于上臂内侧。对于植入剂取出困难的情况，可能会咨询整形和骨科医生。我们进行了一项病例对照研究，比较了在本机构接受手术取出和在办公室顺利取出植入剂的患者。
我们确定了2014年1月至2019年10月期间在本机构由整形或骨科医生进行可植入避孕装置手术取出的患者。将同期接受办公室顺利取出的患者作为对照。收集人口统计学和手术变量，并计算描述性统计数据。以手术取出与门诊取出作为感兴趣的结果进行单因素和多因素逻辑回归分析。
在为期五年的研究期间，共确定了669例接受依托孕烯皮下植入剂取出的患者，其中13例需要手术取出（1.9%），326例被选为顺利取出的对照。中位（四分位间距）体重指数（BMI）（31.1 [28.2, 35.2] 对比 29.3 [24.0, 35.1]，p = 0.19）、自装置置入以来的中位（四分位间距）体重增加量（5 [-0.6, 14.7] 千克对比1.6 [-1.2, 5.8] 千克，p = 0.15）或自装置插入以来的时间长度（2.3 [0.8, 2.8] 年对比1.0 [0.4, 2.2] 年，p = 0.17）均无显著差异。在需要手术取出的患者中，植入剂取出最常见的指征是装置过期（n = 5，38.5%）。由妇产科主治医生置入的装置需要手术取出的可能性较小（p = 0.02）。家庭医学主治医生更有可能将患者转诊进行手术取出（p = 0.02）。单因素或多因素回归均未发现显著结果。在手术取出中，X线摄影是最常用的成像方式。植入剂最常见于皮下（n = 11，84.6%），不过也发现有肌内植入（n = 2，15.4%）。只有1例患者在切口长度范围内有残留感觉异常。未发现其他并发症。
我们未发现与依托孕烯皮下植入剂取出困难相关的危险因素。从业者遇到取出困难时应咨询上肢外科医生。
