title: Predicting negligence in female sterilization failure using time interval to sterilization failure: analysis of 131 cases.
abstract: BACKGROUND
  Sterilization failure due to 'tubal non-occlusion' or 'wrong structure sterilization' is considered negligent, whereas 'spontaneous tubal recanalization' or 'fistula formation' is considered non-negligent. We examined whether interval to pregnancy failure was predictive of a negligent rather non-negligent failure mechanism. We aim to test this hypothesis in a selected population series of known mechanisms of sterilization failure and their time interval to failure.
  
  
  METHODS
  Analyses of 131 failed sterilizations pooled from UK (NHS Litigation Authority, Medical Protection Society and our hospital), Australia and a qualitative systematic review.
  
  
  RESULTS
  We identified 88 negligent and 43 non-negligent sterilization failures. Filshie and ring methods failed earlier than diathermy and Pomeroy methods. Sterilization failure occurred significantly earlier in negligent than non-negligent failure mechanisms [median failure intervals 7.0 versus 12.0 months; Hazard ratio (2.35 95% CI 1.31-4.21)]. Knowing that sterilization failure occurred early, increased the probability that the failure mechanism was likely to be negligent rather than non-negligent.
  
  
  CONCLUSIONS
  A short interval to failure is suggestive of a negligent failure mechanism. There is less certainty in the predictive value of longer time intervals on the mechanism of failure due to a paucity of cases. A national register of failed sterilizations that have been systematically investigated is needed to improve our understanding of negligent and non-negligent failure mechanisms.
authors.affiliation: Obstetrics and Gynaecology, 2nd Floor, Birmingham Women's Hospital, Birmingham B15 2TG, UK. r.varma@bham.ac.uk
authors.forename: Rajesh
authors.initials: R
authors.lastname: Varma
authors.forename: Janesh K
authors.initials: JK
authors.lastname: Gupta
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008318:Malpractice; D011247:Pregnancy; D011336:Probability; D016016:Proportional Hazards Models; D013246:Sterilization, Tubal / Q000379:methods*; D013997:Time Factors