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Risk-reducing salpingectomy at benign hysterectomy: Have surgeons embraced this practice?

Data from a retrospective cross-sectional study of a Michigan multicenter database indicate, yes


 

References

According to its January 2015 Committee Opinion, the American College of Obstetricians and Gynecologists supported the following recommendations and conclusions regarding salpingectomy for ovarian cancer prevention1:

  • The surgeon and patient should discuss the potential benefits of the removal of the fallopian tubes during a hysterectomy in women at population risk of ovarian cancer who are not having an oophorectomy.
  • When counseling women about laparoscopic sterilization methods, clinicians can communicate that bilateral salpingectomy can be considered a method that provides effective contraception.
  • Prophylactic salpingectomy may offer clinicians the opportunity to prevent ovarian cancer in their patients.
  • Randomized controlled trials are needed to support the validity of this approach to reduce the incidence of ovarian cancer.

To determine the change in rate of salpingectomy performed at benign hysterectomy at Michigan hospitals, Sara Till, MD, MPH, and colleagues from the University of Michigan Health System performed a retrospective cross-sectioned study of data from the Michigan Surgical Quality Collaborative. They examined hysterectomies performed for all surgical routes between January 2013 and April 2015. Exclusion criteria included malignancy and obstetric indication. The primary objective was to measure salpingectomy at the time of hysterectomy with ovarian preservation. Measures studied included demographics; comorbidities; perioperative and postoperative results; and hospital/surgeon-related data; including surgeon volume, hospital type (ie, teaching), and hospital size.2

During the study period (January 1, 2013, to April 30, 2015), 18,642 hysterectomies were performed for benign indications, of which 55.7% (n = 10,382) were ovarian conserving. Among patients who underwent ovarian conserving hysterectomy, 44.9% (n = 4,668) had salpingectomy, with rates increasing steadily from 26.4% to 61.1% across the study period (P<.001). Salpingectomy was more likely with a laparoscopic approach (odds ratio [OR], 2.93; 95% confidence interval [CI], 2.69–3.20) and among women aged <60 years (OR, 2.60; 95% CI, 1.42–1.98), but did not vary with surgeon volume. After adjustments for age, body mass index, and surgical approach using a mixed model, the researchers found substantial variation in rates of salpingectomy across hospital sites, ranging from 3.7% to 88.3%. Variation in adjusted salpingectomy rates was not associated with academic affiliation or hospital size.2

Dr. Till and colleagues concluded that there was a substantial rise in risk-reducing salpingectomy from January 1, 2013, to April 30, 2015, and that there is substantial variation in the practice of salpingectomy, which is not accounted for by patient, surgeon, or hospital characteristics.2

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