Trends in permanent contraceptive procedural volume in the United States between 2019 and 2020.

OBJECTIVE: This study aimed to assess trends in the rate of bilateral salpingectomy and bilateral tubal ligation procedures in the United States between 2019 and 2020. STUDY DESIGN: A population-based, retrospective, cross-sectional study was conducted using discharge data from the National Inpatient Sample (NIS), an all-payer administrative claims database covering 98% of the United States.1 All hospitalizations reporting ICD-10-PCS (International Classification of Diseases, 10th Revision-Procedure Coding System) procedure codes for bilateral salpingectomy or bilateral tubal ligation between January 1, 2019 and December 31, 2020 were included (Supplemental Table 1).2 Admissions with newborn delivery were determined by the ICD-10-CM (ICD-10 Clinical Modification) Delivery Indicator reported in the NIS, and concurrently performed procedures were determined by ICD-10-PCS codes and associated procedure days.1 Analyses were done on data weighted to obtain national estimates, with variance estimates derived from the NIS sampling methodology. Linear segmented regression was used to assess monthly percentage change (MPC) in hospitalizations using the National Cancer Institute's Joinpoint Regression Program.3 Briefly, this program fits trend data with linear segments using a minimum number of statistically significant joinpoints, with individual joinpoints serving as the start and end of 2 trend segments. A maximum of 4 joinpoints, 1 gridpoint between observed values, and minimum meaningful MPC difference of 5% were prespecified. Demographic characteristics for admissions during the period of steep decline (February-April 2020) were compared with characteristics for admissions in the same months in 2019 with chi-square tests. Analyses were conducted using IBM SPSS Statistics, Version 29.0 (IBM Corp, Armonk, NY). This study consulted the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for cross-sectional studies4 and was determined to be Not Human Subjects Research by the Mass General Brigham Institutional Review Board. RESULTS: Bilateral salpingectomy and bilateral tubal ligation procedures were performed during 352,270 admissions in 2019 (95% confidence interval [CI], 337,125-367,415) and 304,200 admissions in 2020 (95% CI, 291,016-317,384) (P<.001). Across the study period CONCLUSION: Permanent contraception is a critical women's health service, the access to which was threatened by the COVID-19 pandemic. We found that inpatient salpingectomy and tubal ligation procedures decreased in 2020 compared with 2019, with the sharpest decline during the first wave of the COVID-19 pandemic. This pattern was similar to trends reported for hysterectomy procedural volume.5 Salpingectomy and tubal ligation procedures during admissions with newborn delivery had a shallow decline but were relatively protected from the sharp decline observed in overall procedure volume. We did not find evidence that the decrease in procedure volume disproportionately affected specific economic, racial, or regional subsets of the population. -