Experience With Opportunistic Salpingectomy in a Large,... : Obstetrics & Gynecology (original) (raw)

Contents: Original Research

Experience With Opportunistic Salpingectomy in a Large, Community-Based Health System in the United States

Garcia, Christine MD; Martin, Maria MD; Tucker, Lue-Yen BA; Lyon, Liisa MS; Armstrong, Mary Anne MA; McBride-Allen, Sally BS; Littell, Ramey D. MD; Alabaster, Amy MPH; Raine-Bennett, Tina MD, MPH; Powell, C. Bethan MD

Kaiser Permanente Northern California Gynecologic Cancer Group and the Kaiser Permanente Ob/Gyn Residency Program, San Francisco, and Kaiser Permanente Northern California, Division of Research, Oakland, California; and the Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Virginia, Charlottesville, Virginia.

Corresponding author: C. Bethan Powell, MD, Kaiser Permanente Northern California Gynecologic Cancer Program, 2350 Geary Boulevard, San Francisco CA 94115; e-mail: [email protected].

Financial Disclosure The authors did not report any potential conflicts of interest.

Presented at the Society of Gynecologic Oncology's Annual Meeting, March 19–22, 2016, San Diego, California.

OBJECTIVE:

To evaluate the trend in uptake of salpingectomy at the time of hysterectomy and assess physicians' attitudes toward the practice.

METHODS:

This was a retrospective cohort study using the electronic medical record to identify women 18 years of age or older undergoing hysterectomy from June 2011 to May 2014 in a large integrated health care delivery system. The primary outcome was the change in rate of opportunistic salpingectomy over time and after a systemwide practice recommendation was issued in May 2013. Secondary outcomes included data on blood loss, operating time, and length of stay.

RESULTS:

Of the 12,143 hysterectomies performed over the 3-year study period, 7,498 were performed without oophorectomy. There was a statistically significant rise in rate of salpingectomy over time from 14.7% for June 2011 to May 2012 to 44.6% from June 2012 to May 2013 and to 72.7% from June 2013 to May 2014 (P<.001). Sixty-one percent of laparoscopic hysterectomies were performed with salpingectomy, whereas only 25% of abdominal and 17% of vaginal hysterectomies had salpingectomies. Median estimated blood loss was lower in the salpingectomy group, 100 compared with 150 mL (P<.01). There was a significantly shorter median operating time (147 compared with 154 minutes, _P_=.002) for laparoscopic hysterectomy with bilateral salpingectomy compared with laparoscopic hysterectomy alone.

CONCLUSION:

Rates of salpingectomy increased significantly over time, consistent with the high reported acceptance rate reported by health care providers and highlighting the importance of physician education to improve compliance with risk-reducing clinical strategies.