title: Incidence of opioid-managed pelvic pain after hysteroscopic sterilization versus laparoscopic sterilization, US 2005-2012.
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.
authors.affiliation: Center for Women's Health Research, University of North Carolina at Chapel Hill, 104B Market Street, Chapel Hill, NC, 27704, USA.|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.
authors.forename: Mitchell M
authors.initials: MM
authors.lastname: Conover
authors.affiliation: 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.
authors.forename: Jennifer O
authors.initials: JO
authors.lastname: Howell
authors.affiliation: Center for Women's Health Research, University of North Carolina at Chapel Hill, 104B Market Street, Chapel Hill, NC, 27704, USA.|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.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Wu
authors.affiliation: Center for Women's Health Research, University of North Carolina at Chapel Hill, 104B Market Street, Chapel Hill, NC, 27704, USA.|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.
authors.forename: Alan C
authors.initials: AC
authors.lastname: Kinlaw
authors.affiliation: 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.|Epidemico, Inc., Boston, MA, USA.
authors.forename: Nabarun
authors.initials: N
authors.lastname: Dasgupta
authors.affiliation: Center for Women's Health Research, University of North Carolina at Chapel Hill, 104B Market Street, Chapel Hill, NC, 27704, USA.|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.
authors.forename: Michele
authors.initials: M
authors.lastname: Jonsson Funk
mesh_terms: D000293:Adolescent; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015907:Hysteroscopy / Q000009:adverse effects*; D015994:Incidence; D010535:Laparoscopy / Q000009:adverse effects*; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D017699:Pelvic Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D017891:Pharmacoepidemiology; D057216:Propensity Score; D016016:Proportional Hazards Models; D012720:Severity of Illness Index; D013246:Sterilization, Tubal / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid
keywords: administrative claims; hysteroscopic sterilization; laparoscopic sterilization; opioids; pelvic pain; pharmacoepidemiology
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