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Frequency and characteristics associated with opportunistic salpingectomy at cesarean delivery: A retrospective chart review

      Abstract

      Objectives

      To identify the frequency and characteristics associated with total salpingectomy (TS) versus occlusion or partial salpingectomy (PS) at the time of cesarean delivery.

      Study design

      We performed a retrospective chart review of cesarean deliveries with a concurrent permanent contraception procedure, from July 1, 2014 to June 30, 2019 at 2 hospitals (community hospital and tertiary care academic center) within a single healthcare system. We assessed the proportion of TS versus PS at cesarean, and secondarily compared operative times between the 2 procedures.

      Results

      We identified 2110 procedures during the 5-year period. Surgeons performed TS in 302 (14%, 95% confidence interval [CI] 13%–16%) cases, and the annual rate varied from 14% to 18% over the study period (p = 0.14). Factors associated with increased likelihood of TS rather than PS included public insurance/self-pay (adjusted odds ratio, aOR 2.8, 95% CI 2.0–4.1), delivery at the community hospital (aOR 4.8, 95% CI 3.0–7.7), parity of 5 or more (aOR 2.2, 95% CI 1.1–4.4), and presence of an obstetrician/gynecologist for cesarean delivery (aOR 2.9, 95% CI 1.6–5.4). The total operative time for TS and PS differed at the academic center (90 vs 68 minutes, p < 0.001) but not at the community hospital (55 vs 54 minutes, p = 0.5).

      Conclusions

      This study highlights provider and institutional characteristics associated with TS compared to PS at the time of cesarean delivery, which may inform future programs aimed at increasing utilization of TS at cesarean delivery.

      Implications

      Access to TS at the time of cesarean delivery may provide pregnant women with a very effective permanent contraception method at a convenient time of concurrent cesarean. This study identifies patient factors that may influence access to TS as part of obstetrical care.

      Keywords

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      References

        • Siegel RL
        • Miller KD
        • Jemal A
        Cancer statistics, 2018.
        CA Cancer J Clin. 2018; 68: 7-30
        • Gilks CB
        • Irving J
        • Kobel M
        • Lee C
        • Singh N
        • Wilkinson N
        • et al.
        Incidental nonuterine high-grade serous carcinomas arise in the fallopian tube in most cases: further evidence for the tubal origin of high-grade serous carcinomas.
        Am J Surg Pathol. 2015; 39: 357-364
        • Kurman RJ
        • Shih Ie M
        Molecular pathogenesis and extraovarian origin of epithelial ovarian cancer–shifting the paradigm.
        Hum Pathol. 2011; 42: 918-931
        • Falconer H
        • Yin L
        • Gronberg H
        • Altman D.
        Ovarian cancer risk after salpingectomy: a nationwide population-based study.
        J Natl Cancer Inst. 2015; 107
        • Lessard-Anderson CR
        • Handlogten KS
        • Molitor RJ
        • Dowdy SC
        • Cliby WA
        • Weaver AL
        • et al.
        Effect of tubal sterilization technique on risk of serous epithelial ovarian and primary peritoneal carcinoma.
        Gynecol Oncol. 2014; 135: 423-427
        • Madsen C
        • Baandrup L
        • Dehlendorff C
        • Kjaer SK
        Tubal ligation and salpingectomy and the risk of epithelial ovarian cancer and borderline ovarian tumors: a nationwide case-control study.
        Acta Obstet Gynecol Scand. 2015; 94: 86-94
        • Rice MS
        • Murphy MA
        • Tworoger SS
        Tubal ligation, hysterectomy and ovarian cancer: a meta-analysis.
        J Ovarian Res. 2012; 5: 13
        • Yoon SH
        • Kim SN
        • Shim SH
        • Kang SB
        • Lee SJ
        Bilateral salpingectomy can reduce the risk of ovarian cancer in the general population: a meta-analysis.
        Eur J Cancer. 2016; 55: 38-46
        • ACOG Committee Opinion No. 774
        Opportunistic salpingectomy as a strategy for epithelial ovarian cancer prevention.
        Obstet Gynecol. 2019; 133: e279-ee84
        • Dilley SE
        • Straughn Jr., JM
        • Leath 3rd., CA
        The evolution of and evidence for opportunistic salpingectomy.
        Obstet Gynecol. 2017; 130: 814-824
        • Hanley GE
        • McAlpine JN
        • Pearce CL
        • Miller D
        The performance and safety of bilateral salpingectomy for ovarian cancer prevention in the United States.
        Am J Obstet Gynecol. 2017; 216 (270 e1– e9)
        • Mikhail E
        • Salemi JL
        • Wyman A
        • Salihu HM
        • Imudia AN
        • Hart S
        National trends of bilateral salpingectomy during vaginal hysterectomy with and without laparoscopic assistance, United States 1998-2011.
        J Minim Invasive Gynecol. 2015; 22: S85
        • Walker JL
        • Powell CB
        • Chen LM
        • Carter J
        • Bae Jump VL
        • Parker LP
        • et al.
        Society of Gynecologic Oncology recommendations for the prevention of ovarian cancer.
        Cancer. 2015; 121: 2108-2120
        • Jones NL
        • Schulkin J
        • Urban RR
        • Wright JD
        • Burke WM
        • Hou JY
        • et al.
        Physicians' perspectives and practice patterns toward opportunistic salpingectomy in high- and low-risk women.
        Cancer Invest. 2017; 35: 51-61
        • MacKay AP
        • Kieke Jr., BA
        • Koonin LM
        • Beattie K
        Tubal sterilization in the United States, 1994-1996.
        Fam Plann Perspect. 2001; 33: 161-165
        • Moniz MH
        • Chang T
        • Heisler M
        • Admon L
        • Gebremariam A
        • Dalton VK
        • et al.
        Inpatient postpartum long-acting reversible contraception and sterilization in the United States, 2008-2013.
        Obstet Gynecol. 2017; 129: 1078-1085
        • Whiteman MK
        • Cox S
        • Tepper NK
        • Curtis KM
        • Jamieson DJ
        • Penman-Aguilar A
        • et al.
        Postpartum intrauterine device insertion and postpartum tubal sterilization in the United States.
        Am J Obstet Gynecol. 2012; 206 (127e1–7)
        • Powell CB
        • Alabaster A
        • Simmons S
        • Garcia C
        • Martin M
        • McBride-Allen S
        • et al.
        Salpingectomy for sterilization: change in practice in a large integrated health care system, 2011-2016.
        Obstet Gynecol. 2017; 130: 961-967
        • Duncan JR
        • Jones HL
        • Hoffer SO
        • Schenone MH
        • Mari G
        Bilateral salpingectomy versus bilateral partial salpingectomy during cesarean delivery.
        Int J Womens Health. 2018; 10: 649-653
        • Garcia C
        • Moskowitz OM
        • Chisholm CA
        • Duska LR
        • Warren AL
        • Lyons GR
        • et al.
        Salpingectomy compared with tubal ligation at cesarean delivery: a randomized controlled trial.
        Obstet Gynecol. 2018; 132: 29-34
        • Roeckner JT
        • Sawangkum P
        • Sanchez-Ramos L
        • Duncan JR.
        Salpingectomy at the time of cesarean delivery: a systematic review and meta-analysis.
        Obstet Gynecol. 2020; 135: 550-557
        • Ferrari F
        • Forte S
        • Prefumo F
        • Sartori E
        • Odicino F.
        Opportunistic salpingectomy during postpartum contraception procedures at elective and unscheduled cesarean delivery.
        Contraception. 2019; 99: 373-376
        • Subramaniam A
        • Blanchard CT
        • Erickson BK
        • Szychowski J
        • Leath CA
        • Biggio JR
        • et al.
        Feasibility of complete salpingectomy compared with standard postpartum tubal ligation at cesarean delivery: a randomized controlled trial.
        Obstet Gynecol. 2018; 132: 20-27
        • Subramaniam A
        • Einerson BD
        • Blanchard CT
        • Erickson BK
        • Szychowski J
        • Leath 3rd, CA
        • et al.
        The cost-effectiveness of opportunistic salpingectomy versus standard tubal ligation at the time of cesarean delivery for ovarian cancer risk reduction.
        Gynecol Oncol. 2019; 152: 127-132
        • Venkatesh KK
        • Clark LH
        • Stamilio DM
        Cost-effectiveness of opportunistic salpingectomy vs tubal ligation at the time of cesarean delivery.
        Am J Obstet Gynecol. 2019; 220 (106e1–e10)
        • Piazza A
        • Schwirian K
        • Scott F
        • Wilson MD
        • Zite NB
        • Creinin MD
        Women's preferences for permanent contraception method and willingness to be randomized for a hypothetical trial.
        Contraception. 2019; 99: 56-60
        • Lehn K
        • Gu L
        • Creinin MD
        • Chen MJ
        Successful completion of total and partial salpingectomy at the time of cesarean delivery.
        Contraception. 2018; 98: 232-236
      1. Quantitative blood loss in obstetric hemorrhage: ACOG committee opinion, number 794.
        Obstet Gynecol. 2019; 134: e150-e1e6
        • Rubenstein AF
        • Zamudio S
        • Al-Khan A
        • Douglas C
        • Sledge S
        • Tully G
        • et al.
        Clinical experience with the implementation of accurate measurement of blood loss during cesarean delivery: influences on hemorrhage recognition and allogeneic transfusion.
        Am J Perinatol. 2018; 35: 655-659
        • Morris J
        • Ascha M
        • Wilkinson B
        • Verbus E
        • Montague M
        • Mercer BM
        • et al.
        Desired sterilization procedure at the time of cesarean delivery according to insurance status.
        Obstet Gynecol. 2019; 134: 1171-1177