Characteristics of Patients Requiring Surgical Removal of Subdermal Contraceptive Implants: A Case–Control Study

Figures & data

Table 1 Patient Demographics for Office versus Surgical Nexplanon Removal

		Office Removal	Surgical Removal	P
Total number		326	13
Age (median [IQR])		23.34 [19.50, 26.82]	19.99 [17.79, 21.61]	0.06
Race/ethnicity (%)	Caucasian	84 (25.8%)	5 (38.5%)	0.73
	African American	170 (52.1%)	4 (30.8%)
	Hispanic	58 (17.8%)	4 (30.8%)
	Pacific Islander	2 (0.6%)	0
	Native American/Alaska Native	3 (0.9%)	0
	Asian	2 (0.6%)	0
	Unknown	7 (2.1%)	0
Parity	0	127 (39.0%)	8 (61.5%)	0.61
	1	89 (27.3%)	3 (23.1%)
	2	68 (20.9%)	1 (7.7%)
	3	21 (6.4%)	0
	4	12 (3.7%)	1 (7.7%)
	≥5	5 (1.5%)	0
	Unknown	4 (1.2%)	0
BMI at removal (median [IQR])		29.26 [23.96, 35.09]	31.09 [28.15, 35.24]	0.19
Weight gained since insertion (kg) (median [IQR])		1.6 [−1.2, 5.77]^a	5 [−0.6, 14.65]^b	0.15
Smoking status	Current	92 (28.2%)	2 (15.4%)	0.73
	Former	34 (10.4%)	2 (15.4%)
	Never	197 (60.4%)	9 (69.2%)
	Unknown	3 (0.9%)	0
Comorbidities	Hypertension	20 (6.1%)	2 (15.4%)	0.20
	Diabetes mellitus	12 (3.7%)	0	1.00
	Sickle cell anemia	9 (2.8%)	1 (7.7%)	0.33
	Polycystic ovarian syndrome	9 (2.8%)	0	1.00

Note: ^aData missing from 79 patients; ^bData missing from 8 patients.

Abbreviations: IQR, interquartile range; BMI, body mass index.

Table 2 Factors Related to Nexplanon Insertion and Removal

		Office Removal	Surgical Removal	P
		n (%)	n (%)
Total number		326	13
Extremity of implant	Right	34 (10.4)	3 (23.1)	0.16
	Left	247 (75.8)	10 (76.9)
	NA	45 (13.8)	0
Placement provider specialty	OB/GYN resident	20 (6.1)	1 (7.7)	1.00
	OB/GYN attending	116 (35.6)	0	0.03
	OB/GYN nurse practitioner	37 (11.3)	1 (7.7)	1.00
	Family Medicine Resident	18 (5.5)	0	0.81
	Family medicine attending	32 (9.8)	2 (15.4)	0.85
	Family medicine nurse practitioner	8 (2.5)	0	1.00
	Other department (including pediatrics, internal medicine, etc)	8 (2.5)	3 (23.1)	0.56
Reason for removal	Desire to conceive	45 (13.8)	2 (15.4)	1.00
	Implant reached expiry	63 (19.3)	5 (38.5)	0.18
	Undesired weight gain	31 (9.5)	1 (7.7)	1.00
	Unfavorable bleeding pattern	149 (45.7)	4 (30.8)	0.44
	Headaches	19 (5.8)	0	0.78
	Irritability	37 (11.3)	0	0.41
	Other	63 (19.3)	2 (15.4)	1.00
	Unknown	2 (0.6)	1 (7.7)	0.25
Years with Nexplanon		1.03 [0.42, 2.23]	2.27 [0.81, 2.77]	0.17
Initial office removal attempt provider specialty	OB/GYN resident	21 (6.4)	1 (7.7)	1.00
	OB/GYN attending	208 (63.8%)	7 (53.8)	0.66
	OB/GYN nurse practitioner	43 (13.2)	0	0.33
	Family medicine resident	16 (4.9)	1 (7.7)	1.00
	Family medicine attending	25 (7.7)	4 (30.8)	0.02
	Family medicine nurse practitioner	8 (2.5)	1 (7.7)	0.79
Contraceptive chosen after removal	Nothing	86 (26.4)	4 (30.8)	0.98
	Oral contraceptive	102 (31.3)	6 (46.2)	0.41
	Copper IUD	5 (1.5)	1 (7.7)	0.56
	Hormonal IUD	14 (4.3)	1 (7.7)	1.00
	Nexplanon	11 (3.4)	1 (7.7)	0.95
	Depo-Provera	34 (10.4)	0	0.45
	NuvaRing	10 (3.1)	0	1.00
	Barrier	40 (12.3)	0	0.37
	Permanent sterilization	3 (0.9)	0	1.00
	Other	13 (4.0)	0	1.00
	Unknown	1 (0.3)	0	1.00

Abbreviations: OB/GYN, obstetrician gynecologist; IUD, intrauterine device.

Table 3 Characteristics of Patients Requiring Surgical Nexplanon Removal

n = 13		n (%)
Reason for surgical removal	Unable to palpate	8 (61.5)
	Unsuccessful attempt at office removal	7 (53.8)
	Broken implant	1 (7.7)
Imaging utilized	Ultrasound	7 (53.8)
	XR humerus	9 (69.2)
	Intraoperative fluoroscopy	6 (46.2)
Anesthesia	General	6 (46.2)
	Local	7 (53.8)
Operative time (minutes) (median, [IQR])		23.5 [16, 33]
Complications	Residual nerve impairment	1 (7.7)
	Residual motor impairment	0
Location of implant	Subdermal	11 (84.6)
	Intramuscular	2 (15.4)

Abbreviation: IQR, interquartile range.

Table 4 Results of Univariate and Multivariate Regression

Variable	Univariate Regression			Multivariate Regression
	Odds Ratio	95% Confidence Interval	P-value	Univariate Odds Ratio	95% Confidence Interval	P-value
Age	0.87	0.71–1.01	0.11	0.84	0.60–1.04	0.21
Weight difference between insertion and removal (kg)	1.06	0.96–1.16	0.21	1.06	0.94–1.21	0.36
Parity	0.69	0.35–1.16	0.21	1.54	0.55–3.99	0.37
Duration of implant (days)	1.0	1.0–1.0	0.14	1.0	1.0–1.0	0.61
Ethnicity – African American	0.40	0.10–1.53	0.17	0.22	0.02–2.17	0.18
Ethnicity – Hispanic	1.16	0.28–4.56	0.83	0.30	0.01–4.21	0.40
Ethnicity – other	<0.01	NA*	0.99	<0.01	NA*	1.0
Smoking status – former smoker	2.70	0.31–23.29	0.33	>100	NA*	0.99
Smoking status – never smoker	2.1	0.53–13.96	0.35	>100	NA*	0.99

Note: *NA represents confidence intervals that are infinitely wide.