Case-fatality rates for tubal sterilization in U.S. hospitals, 1979 to 1980

Abstract

To update a 1977 to 1978 case-fatality estimate for tubal sterilization in U.S. hospitals, we reviewed the medical records of women reported by the Commission on Professional and Hospital Activities to have died after tubal sterilization procedures in 1979 or 1980. We project that the most reasonable case-fatality rate estimate is slightly greater than 9 per 100,000 sterilizations if all deaths associated with the procedure are considered. Rate estimates that assume minimum and maximum numbers of all associated deaths in our sample are approximately 6 per 100,000 and 10 per 100,000 sterilizations, respectively. However, when only deaths that can be attributed to sterilization per se are considered, the most reasonable case-fatality rate is estimated at between 1 and 2 per 100,000 procedures, a lower rate than previously reported. Rate estimates that assume minimum and maximum numbers of attributable deaths in our sample are approximately 1 per 100,000 and 5 per 100,000 sterilizations, respectively. These results further indicate that death attributable to tubal sterilization is rare.

PIP: The medical records of women reported by the US Commission on Professional and Hospital Activities to have died after tubal sterilization procedures in 1979-80 were reviewed to obtain current case-fatality estimates. The previous estimate, which used data from 1977 and 1978, was 3.6/100,000 procedures. The Commission identified 53 women who had tubal sterilization and who died during hospitalization; however, permission to review medical records was obtained for only 37 of these women. Of these 37 deaths, 28 were associated with sterilization and 9 involved coding errors. Of the 28 sterilization-associated deaths, 17 were attributable to concurrent cesarean section and 7 were attributable to other concurrent procedures. Of the 3 women whose deaths were clearly related to the sterilization procedure, 2 had no underlying illnesses and 1 had severe congenital heart disease (which may have contributed to her death). In the 4th case, the probable cause of death was intracranial hemorrhage caused by pregnancy-induced hypertension. The 28 sterilization-associated deaths occurred among a total population of 433,744 women who received tubal sterilizations in US hospitals in 1979 and 1980. Since 28 of the 37 deaths reviewed were associated with sterilization, it was assumed that 76% of the unreviewed deaths were sterilization-associated. This assumption results in a total number of 40 deaths and a case-fatality rate of 9.2/100,000 procedures. Use of the same procedure suggests a sterilization-attributable case-fatality rate of 1.5/100,000. In view of the small number of deaths involved, the decline in sterilization-attributable deaths from 1977-78 and 1979-80 should not be interpreted as a trend over time. However, these results confirm the belief that death attributable to tubal sterilization is a rare event.