25832014

PMC4527877

1UL1RR025747/RR/NCRR NIH HHS/United States
1UL1TR001111/TR/NCATS NIH HHS/United States
2R49CE002479/CE/NCIPC CDC HHS/United States
K02 HS017950/HS/AHRQ HHS/United States
K23 HD068404/HD/NICHD NIH HHS/United States
K23HD0068404/HD/NICHD NIH HHS/United States
R01 AG023178/AG/NIA NIH HHS/United States
R01 AG023178/AG/NIA NIH HHS/United States
R01 HL118255/HL/NHLBI NIH HHS/United States
R01 HL118255/HL/NHLBI NIH HHS/United States
UL1 RR025747/RR/NCRR NIH HHS/United States
UL1 TR001111/TR/NCATS NIH HHS/United States

CDC Public Access

Objective

Compare incidence of opioid-managed pelvic pain within 12-months after hysteroscopic and laparoscopic sterilization.

Methods

Using administrative claims, we identified women age 18-49 without recent history of childbirth who underwent hysteroscopic or laparoscopic sterilization between 2005-2012. 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.