Difficult IUD Removals

Abstract

INTRODUCTION: We evaluated the outcomes of all IUD removals in an OB/GYN practice over a three-year period and to compared the patient costs of difficult removals—office ultrasound-guided removal, office hysteroscopic removal, and hysteroscopic removal in the operating room. METHODS: A retrospective chart review was performed. Data extracted included age, parity, body mass index, IUD type, length of time IUD inserted, number of removal attempts, and successful removal. Of the patients with unsuccessful removals requiring operative intervention, billing costs were obtained. The study outcome was comparison of patient costs of operative IUD removals. Secondary outcomes will be discussed. RESULTS: We had 282 women present for IUD removal meet inclusion criteria for chart evaluation. Of these, 234 (83%) had a successful removal on their first visit. Of the 48 (17%) unsuccessful removals on initial presentation, 29 (10%) required operative removal. Older age and greater BMI were associated with unsuccessful removal on first attempt (P<.05). Parity or IUD type were not predictors of successful removal. Retained IUD removal in the operating room was significantly more expensive than removal with either office-based approach (P<.0001). There was no statistically significant difference in patient cost between office-based hysteroscopy and ultrasound-guided removal. CONCLUSION: In this cost comparison, removal of retained intrauterine devices in the office is more cost-effective than removal in the surgical suite. The authors propose that office-based removal should be the standard of care in the management of all retained IUDs.