1. Leveraging Claims Data to Assess Outcomes Following Hysteroscopic Sterilization
Jialin Mao
WCMC
Co-investigators: Maryam Guiahi, Scott Chudnoff, Peter Schlegel, Samantha Pfeifer, Art Sedrakyan

3. Other studies… Perkins (2016) – US commercial claims database
Did not separate subsequent tubal intervention from other GYN procedures
Did not include Medicaid patients

4. Other studies…
Antoun (2017) – Birmingham Women’s Hospital, UK

5. Other studies…
Bouillon (2017) – French National Discharge Database

6. How does HS compare to LS in longer terms?

7. Current study Cohort Main outcomes Secondary outcomes
New York State database of all comers, undergoing HS or LS,
Median follow-up of 7 years
Main outcomes
Additional tubal ligations or resections
Hysterectomy not related to gynecologic malignancies, uterine leiomyomata, or benign uterine tumors
Secondary outcomes
Gynecologic and non-gynecologic cancer in a baseline cancer-free sub-cohort
Statistical analysis
Propensity score matching
Time-to-event analysis

8. Primary outcomes within 7-year follow up, propensity matched cohort
HR(95% CI)
HS vs. LS
P value
Additional tubal ligation/resection
All years
2.89( )
<.001
Time dependent covariate
Year 1
6.39( )
Year 2
2.86( )
Year 3-7
1.65( )
0.001
Hysterectomy
0.73( )
0.05

9. Hysteroscopic Sterilization (n=10053) Laparoscopic Sterilization
Secondary analysis of new cancer diagnosis within 7 years among patients who did not have cancer at baseline, propensity score matched cohort.
Hysteroscopic Sterilization
(n=10053)
Laparoscopic Sterilization
Hazard Ratio
(95% CI)
P value
Events
Estimated Risk
GYN cancer NR
0.1%
2.63( )
0.15
Other cancer 91
1.2% 93
1.3%
0.96( )
0.80
Any cancer* 98 94
1.03( )
0.85
* Any cancer incidence was not equal to the sum of gynecologic cancer and other cancer incidence due to multiple cancer diagnosis for some patients.
NR: Not reportable for events<11.

10. Summary
Higher risk of tubal reoperation following HS compared to LS in short- and longer-term
Time-varying risk

11. Thank you!