Mitchell M Conover1,2, Jennifer O Howell3, Jennifer M Wu1,3, Alan C Kinlaw1,2, Nabarun Dasgupta4,5, Michele Jonsson Funk1,2. 1. Center for Women's Health Research, University of North Carolina at Chapel Hill, 104B Market Street, Chapel Hill, NC, 27704, USA. 2. 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. 3. Department of Obstetrics and Gynecology, School of Medicine, University of North Carolina at Chapel Hill, 3009 Old Clinic Building, Chapel Hill, NC, 27599-7570, USA. 4. Injury Prevention Research Center, University of North Carolina at Chapel Hill, CVS Plaza, Suite 500, 137 East Franklin Street, Chapel Hill, NC, 27599-7505, USA. 5. Epidemico, Inc., Boston, MA, USA.
Abstract
OBJECTIVE: Compare incidence of opioid-managed pelvic pain within 12 months after hysteroscopic and laparoscopic sterilization. METHODS: 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]). RESULTS: 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. CONCLUSIONS: 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.
OBJECTIVE: Compare incidence of opioid-managed pelvic pain within 12 months after hysteroscopic and laparoscopic sterilization. METHODS: 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]). RESULTS: 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. CONCLUSIONS: 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.
Authors: Sean Duffy; Fiona Marsh; Lynne Rogerson; Heather Hudson; Kevin Cooper; Stuart Jack; David Hunter; Graham Philips Journal: BJOG Date: 2005-11 Impact factor: 6.531
Authors: Chi Y Bahk; Melanie Goshgarian; Krystal Donahue; Clark C Freifeld; Christopher M Menone; Carrie E Pierce; Harold Rodriguez; John S Brownstein; Robert Furberg; Nabarun Dasgupta Journal: Pharmaceut Med Date: 2015-08-05