Department of Obstetrics and Gynecology, Division of Family Planning, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
Department of Obstetrics and Gynecology, Division of Family Planning, University of Colorado Anschutz Medical Campus, Aurora, CO, United States.
Contraception. 2024 Sep;137:110486. doi: 10.1016/j.contraception.2024.110486. Epub 2024 May 14.
To identify factors associated with the need for a deep etonogestrel contraceptive implant removal as compared to superficial removal.
We conducted a retrospective cohort study of patients undergoing contraceptive implant removal from January 2014 to January 2023. We extracted key patient characteristics from electronic health record review and compared patients requiring deep removal versus routine superficial removal using Chi-squared, Fischer's exact, and Mann-Whitney U test. A multivariate logistic regression identified variables associated with increased odds of requiring a deep implant removal.
The deep and superficial removal groups included 162 and 585 patients, respectively. Deep removal was associated with younger age at removal (median 25.0 vs 26.0 years, p = 0.005), lower body mass index (BMI) at insertion (median 23.2 kg/m vs 26.6 kg/m, p = 0.024), BMI≥ 40 kg/m at removal (15.2% vs 7.0%, p = 0.007), weight gain during implant use (median 6.6 vs 1.8 kg, p ≤ 0.001), longer duration of use (median 36.0 vs 27.5 months, p < 0.001), implant exchange (37.3% vs 17.4%, p < 0.001), and insertion by non-physician (43.3% vs 19.3%, p < 0.001) or non-obstetrican and gynecologist (31.4% vs 11.8%, p < 0.001). Lower BMI at insertion (aOR 0.92, [95% CI 0.87-0.98]), weight gain during use (aOR 1.06 [95% CI 1.02-1.10]), and longer duration of use (aOR 1.05 [95% CI 1.02-1.07]) remained significantly associated with deep removal in regression analysis.
CONCLUSION(S): We identified lower BMI at insertion, weight gain during use, and longer duration of use as independent factors associated with increased likelihood of needing a deep contraceptive implant removal.
Clinicians should utilize proper technique when inserting contraceptive implants, especially in patients at risk for deep insertion, and ensure immediate referral to Centers of Experience for patients with non-palpable implants.
确定与深层依托孕烯皮下埋植剂取出相比，浅层取出所需的相关因素。
我们对 2014 年 1 月至 2023 年 1 月期间接受皮下埋植剂取出的患者进行了回顾性队列研究。我们从电子健康记录回顾中提取了关键患者特征，并使用卡方检验、Fisher 确切检验和曼-惠特尼 U 检验比较了需要深层取出和常规浅层取出的患者。多变量逻辑回归确定了与增加深层植入物取出几率相关的变量。
深层和浅层取出组分别包括 162 例和 585 例患者。深层取出与取出时年龄较小（中位数 25.0 岁 vs. 26.0 岁，p=0.005）、插入时体重指数（BMI）较低（中位数 23.2kg/m vs. 26.6kg/m，p=0.024）、取出时 BMI≥40kg/m（15.2% vs. 7.0%，p=0.007）、使用植入物期间体重增加（中位数 6.6kg vs. 1.8kg，p≤0.001）、使用时间较长（中位数 36.0 个月 vs. 27.5 个月，p<0.001）、植入物更换（37.3% vs. 17.4%，p<0.001）、非医生（43.3% vs. 19.3%，p<0.001）或非妇产科医生（31.4% vs. 11.8%，p<0.001）插入有关。插入时 BMI 较低（OR 0.92，95%CI 0.87-0.98）、使用期间体重增加（OR 1.06，95%CI 1.02-1.10）和使用时间较长（OR 1.05，95%CI 1.02-1.07）在回归分析中仍与深层取出显著相关。
我们发现，插入时 BMI 较低、使用期间体重增加和使用时间较长是与需要深层避孕植入物取出相关的独立因素。
临床医生在插入避孕植入物时应采用适当的技术，特别是在有深层插入风险的患者中，并确保对不可触及植入物的患者立即转介至经验中心。
