HB Peterson, F DeStefano, JR Greenspan and HW Ory,
American journal of obstetrics and gynecology, May 1982 15
Despite the millions of women who have undergone tubal sterilization in United States hospitals, little has been published about the risk of death from these procedures. To estimate a case-fatality rate of tubal sterilization, we combined data from the Commission on Professional and Hospital Activities and the National Center for Health Statistics with a review of the clinical circumstances for each woman whose death was identified as being potentially sterilization attributable. Considering all deaths temporally associated with tubal sterilization, we estimate that the case-fatality rate is nearly 8/100,000 procedures. When only deaths determined to be attributable to the sterilization operation per se are considered, the case-fatality rate is approximately 4/100,000 procedures, making death attributable to tubal sterilization a rear event.To obtain an accurate estimate of the risk of dying from tubal sterlization, the Centers for Disease Control (CDC) combined an analysis of national data on numbers and characteristics of sterilization procedures with a review of individual medical records for women whose deaths were identified as being associated with sterilization. This estimate was refined to include just those deaths actually attributable to the sterilization operation. Data for calculating case factality rates in this study are based on information for the years 1977 and 1978, obtained from the Commission on Professional and Hospital Activities (CPHA) and the National Center for Health Statistics in their National Hospital Discharge Survey. To identify deaths that were potentially sterilization attributable, the CPHA performed a computer-file search to identify patients who died during hospitalization and who also underwent a procedure coded 66.2 (bilateral salpingectomy), 66.3 (endoscopic bilateral salpingectomy), or 66.4 (other bilateral destruction, ligation, and division of fallopian tubes). To make estimates of the denominator, the total number of tubal sterilizations performed in Professional Activity Study (PAS) hospitals in 1977 and 1978 were determined. The CPHA computer-file search identified 63 deaths as potentially sterilization attributable. Of these 63, 38 deaths were reviewed after permission was given by hospital administrators. For the other 25 deaths, hospital administrators refused to cooperate. Of the 38 deaths reviewed, 25 were sterilization associated. The remaining 13 involved miscoding, i.e., either the woman did not die, did not have a sterilization procedure, or had PAS numbers which hospitals could not identify. The 25 sterilization-associated deaths occurred in connection with 521,400 tubal sterilization procedures peformed in PAS hospitals in 1977 and 1978. Of the 25 sterilization-associated deaths, only 9 were determined to be sterilization attributable. Since 9 of 38 of the deaths reviewed were sterilization attributable, it can be assumed that 23.7% or 6 of the 25 deaths that were not reviewed were also sterilization attributable. If this assumption is correct, a total of 15 sterilization-attributable deaths occurred, resulting in a case-fatality rate of 3.6/100,000 tubal sterilization. If none of the 25 deaths was sterilization attributable, the case-fatality rate would be 2.2/100,000 tubal sterilizations. Death attributable to tubal sterilization is rare, occurring at the rate of approximately 4/100,000 procedures.