Long-term outcomes after elective sterilization procedures — a comparative retrospective cohort study of Medicaid patients

Abstract

Objectives: The objectives were to compare the long-termoutcomes, 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. Study design: This was a retrospective observational cohort analysis using data from the US Medicaid Analytic Extracts Encounters database.Women aged 18 to 49 years with at least one claimfor 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 24 months 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. Results: Postmatching analyses were performed at 6, 12 and 24 months post index procedure. At 24 months, 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 diagnoseswere 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 24 months poststerilization. Conclusion: In Medicaid patients,HS is associated with a significantly lower risk of hysterectomyor CPP diagnosis 24 months 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. Implications statement: This propensity score matching analysis confirms that pelvic pain andAUBarecommon 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 24 months poststerilization when compared to TL