Characteristics of Patients Requiring Surgical Removal of Subdermal Contraceptive Implants: A Case-Control Study.
Characteristics of Patients Requiring Surgical Removal of Subdermal Contraceptive Implants: A Case-Control Study.
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DOI：
10.2147/oajc.s368250
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发表时间：
2022
影响因子：
2.1
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中科院分区：
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依托诺孕酮皮下埋植剂是一种常用的避孕装置，放置在上臂内侧。对于难以取出的植入物，可以咨询整形外科和整形外科医生。我们进行了一项病例对照研究，比较了在我们机构接受手术和不复杂的办公室内摘除的患者。我们确定了2014年1月至2019年10月期间在我们机构接受整形或整形外科医生手术取出植入式避孕器的患者。在同一时间内进行简单办公室搬迁的患者进行了比较。收集人口统计学和外科手术变量，并计算描述性统计数据。单变量和多变量Logistic回归分析以手术切除和门诊切除作为研究结果。在五年的研究期间，共有669名患者接受了依托诺孕酮皮下埋植剂的摘除，其中13名患者需要手术摘除(1.9%)，326名患者被选为不复杂的摘除比较。中位数体重指数(BMI)(31.1[2 8.2，35.2]vs 2 9.3[2 4.0，35.1]，p=0.19)、放置避孕器后体重增加中位数(5[−0.6，14.7]公斤vs 1.6[−1.2，5.8]公斤，p=0.15)，或放置置器后的时间长度(2.3[0.8，2.8]年vs 1.0[0.4，2.2]年，p=0.15)无显著差异。P=0.17)。在那些需要手术取出的人中，最常见的植入物取出指征是装置失效(n=5，38.5%)。OBGYN主治医生放置的装置不太可能需要手术移除(p=0.02)。家庭内科主治医师更倾向于建议患者接受手术切除(p=0.02)。单因素或多因素回归分析均未发现有意义的结果。在手术切除中，X光照相是最常用的成像手段。植入物最常见的是皮下植入(n=11，84.6%)，但也有肌肉内植入(n=2，15.4%)。只有一名患者在整个切口处有残留的感觉异常感。未发现其他并发症。我们没有确定与难以取出依托诺孕酮皮下埋植剂相关的危险因素。如果医生遇到手术困难，应咨询上肢外科医生。
Etonogestrel subdermal implants are a commonly used contraceptive device placed in the medial upper arm. Plastic and orthopedic surgeons may be consulted for difficult implant removals. We performed a case–control study comparing patients undergoing surgical and uncomplicated in-office removal at our institution. We identified patients who underwent operative removal of implantable contraceptive devices by plastic or orthopedic surgeons at our institution from January 2014 to October 2019. Patients who underwent uncomplicated office removal during the same time were compared. Demographic and surgical variables were collected, and descriptive statistics were calculated. Univariate and multivariate logistic regression was performed with surgical versus outpatient removal as the outcome of interest. A total of 669 patients undergoing etonogestrel subdermal implant removals were identified during the five-year study period, of which thirteen patients required surgical removal (1.9%) and 326 were selected as uncomplicated removal comparisons. There were no significant differences in median (IQR) body mass index (BMI) (31.1 [28.2, 35.2] versus 29.3 [24.0, 35.1], p = 0.19), median (IQR) weight gain since device placement (5 [−0.6, 14.7] kilograms versus 1.6 [−1.2, 5.8] kilograms, p = 0.15), or length of time since device insertion (2.3 [0.8, 2.8] years versus 1.0 [0.4, 2.2] years, p = 0.17). Of those who needed surgical removal, the most common indication for implant removal was device expiration (n = 5, 38.5%). Devices placed by OBGYN attendings were less likely to require surgical removal (p = 0.02). Family medicine attendings were more likely to refer patients for surgical removal (p = 0.02). No significant findings were detected on univariate or multivariate regression. Among surgical removals, radiography was the most frequently used imaging modality. Implants were most frequently subdermal (n = 11, 84.6%) though intramuscular placement was also identified (n = 2, 15.4%). Only one patient had residual paresthesia along the length of the incision. No other complications were identified. We did not identify risk factors associated with the difficult removal of etonogestrel subdermal implants. Practitioners should consult upper extremity surgeons if they encounter difficult removals.