Abstract：
OBJECTIVE: To identify factors associated with the need for a deep etonogestrel contraceptive implant removal as compared to superficial removal.
METHODS: We conducted a retrospective cohort study of patients undergoing contraceptive implant removal from January 2014 to January 2023. We extracted key patient characteristics from electronic health record review and compared patients requiring deep removal versus routine superficial removal using Chi-squared, Fischer\'s exact, and Mann-Whitney U test. A multivariate logistic regression identified variables associated with increased odds of requiring a deep implant removal.
RESULTS: The deep and superficial removal groups included 162 and 585 patients, respectively. Deep removal was associated with younger age at removal (median 25.0 vs 26.0 years, p = 0.005), lower body mass index (BMI) at insertion (median 23.2 kg/m2 vs 26.6 kg/m2, p = 0.024), BMI≥ 40 kg/m2 at removal (15.2% vs 7.0%, p = 0.007), weight gain during implant use (median 6.6 vs 1.8 kg, p ≤ 0.001), longer duration of use (median 36.0 vs 27.5 months, p < 0.001), implant exchange (37.3% vs 17.4%, p < 0.001), and insertion by non-physician (43.3% vs 19.3%, p < 0.001) or non-obstetrican and gynecologist (31.4% vs 11.8%, p < 0.001). Lower BMI at insertion (aOR 0.92, [95% CI 0.87-0.98]), weight gain during use (aOR 1.06 [95% CI 1.02-1.10]), and longer duration of use (aOR 1.05 [95% CI 1.02-1.07]) remained significantly associated with deep removal in regression analysis.
CONCLUSIONS: We identified lower BMI at insertion, weight gain during use, and longer duration of use as independent factors associated with increased likelihood of needing a deep contraceptive implant removal.
CONCLUSIONS: Clinicians should utilize proper technique when inserting contraceptive implants, especially in patients at risk for deep insertion, and ensure immediate referral to Centers of Experience for patients with non-palpable implants.
METHODS: We conducted a retrospective cohort study of patients undergoing contraceptive implant removal from January 2014 to January 2023. We extracted key patient characteristics from electronic health record review and compared patients requiring deep removal versus routine superficial removal using Chi-squared, Fischer\'s exact, and Mann-Whitney U test. A multivariate logistic regression identified variables associated with increased odds of requiring a deep implant removal.
RESULTS: The deep and superficial removal groups included 162 and 585 patients, respectively. Deep removal was associated with younger age at removal (median 25.0 vs 26.0 years, p = 0.005), lower body mass index (BMI) at insertion (median 23.2 kg/m2 vs 26.6 kg/m2, p = 0.024), BMI≥ 40 kg/m2 at removal (15.2% vs 7.0%, p = 0.007), weight gain during implant use (median 6.6 vs 1.8 kg, p ≤ 0.001), longer duration of use (median 36.0 vs 27.5 months, p < 0.001), implant exchange (37.3% vs 17.4%, p < 0.001), and insertion by non-physician (43.3% vs 19.3%, p < 0.001) or non-obstetrican and gynecologist (31.4% vs 11.8%, p < 0.001). Lower BMI at insertion (aOR 0.92, [95% CI 0.87-0.98]), weight gain during use (aOR 1.06 [95% CI 1.02-1.10]), and longer duration of use (aOR 1.05 [95% CI 1.02-1.07]) remained significantly associated with deep removal in regression analysis.
CONCLUSIONS: We identified lower BMI at insertion, weight gain during use, and longer duration of use as independent factors associated with increased likelihood of needing a deep contraceptive implant removal.
CONCLUSIONS: Clinicians should utilize proper technique when inserting contraceptive implants, especially in patients at risk for deep insertion, and ensure immediate referral to Centers of Experience for patients with non-palpable implants.
摘要：
目的：确定与去除表面相比，需要去除深层依托孕烯避孕植入物的相关因素。
方法：我们对2014年1月至2023年1月接受避孕植入物摘除的患者进行了回顾性队列研究。我们从电子健康记录审查中提取了关键的患者特征，并使用卡方比较了需要深度切除与常规浅层切除的患者，Fischer的精确,和曼-惠特尼U测试。多变量逻辑回归确定了与需要深度植入物移除的几率增加相关的变量。
结果：深层和浅层切除组包括162和585名患者，分别。深度切除与切除时年龄较小相关(中位数为25.0岁vs26.0岁，p=0.005),插入时体重指数（BMI）较低（中位数23.2kg/m2vs26.6kg/m2，p=0.024），去除时BMI>40kg/m2(15.2%vs7.0%，p=0.007),植入物使用期间的体重增加(中位数6.6vs1.8kg，p=<0.001)，使用时间更长(中位数为36.0个月对27.5个月，p<0.001)，植入物交换(37.3%对17.4%，p<0.001)，并由非医师插入(43.3%对19.3%，p<0.001）或非OB/GYN（31.4%vs11.8%，p<0.001)。插入时BMI较低（aOR0.92，[95%CI0.87-0.98]），使用过程中的体重增加(aOR1.06[95%CI1.02-1.10])，在回归分析中,使用时间较长(aOR为1.05[95%CI为1.02-1.07])与深度去除显著相关.
结论：我们发现插入时BMI较低，在使用过程中体重增加，和更长的使用时间是与需要深度避孕植入物移除的可能性增加相关的独立因素。
结论：临床医生在插入避孕植入物时应使用适当的技术，特别是在有深度插入风险的患者中，并确保对无法触及的植入物患者立即转诊至经验中心。
方法：我们对2014年1月至2023年1月接受避孕植入物摘除的患者进行了回顾性队列研究。我们从电子健康记录审查中提取了关键的患者特征，并使用卡方比较了需要深度切除与常规浅层切除的患者，Fischer的精确,和曼-惠特尼U测试。多变量逻辑回归确定了与需要深度植入物移除的几率增加相关的变量。
结果：深层和浅层切除组包括162和585名患者，分别。深度切除与切除时年龄较小相关(中位数为25.0岁vs26.0岁，p=0.005),插入时体重指数（BMI）较低（中位数23.2kg/m2vs26.6kg/m2，p=0.024），去除时BMI>40kg/m2(15.2%vs7.0%，p=0.007),植入物使用期间的体重增加(中位数6.6vs1.8kg，p=<0.001)，使用时间更长(中位数为36.0个月对27.5个月，p<0.001)，植入物交换(37.3%对17.4%，p<0.001)，并由非医师插入(43.3%对19.3%，p<0.001）或非OB/GYN（31.4%vs11.8%，p<0.001)。插入时BMI较低（aOR0.92，[95%CI0.87-0.98]），使用过程中的体重增加(aOR1.06[95%CI1.02-1.10])，在回归分析中,使用时间较长(aOR为1.05[95%CI为1.02-1.07])与深度去除显著相关.
结论：我们发现插入时BMI较低，在使用过程中体重增加，和更长的使用时间是与需要深度避孕植入物移除的可能性增加相关的独立因素。
结论：临床医生在插入避孕植入物时应使用适当的技术，特别是在有深度插入风险的患者中，并确保对无法触及的植入物患者立即转诊至经验中心。
