Adnexectomy at the time of vaginal hysterectomy for pelvic organ prolapse

• Published in: International Urogynecology Journal Vol. 31; no. 2; pp. 373 - 379
• Main Authors: Slopnick, Emily A., Sheyn, David D., Chapman, Graham C., Mahajan, Sangeeta T., El-Nashar, Sharif, Hijaz, Adonis K.
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.02.2020; Springer Nature B.V
• Subjects: Aged; Combined Modality Therapy; Databases, Factual; Female; Gynecology; Health risk assessment; Humans; Hysterectomy; Hysterectomy, Vaginal - methods; Hysterectomy, Vaginal - statistics & numerical data; Logistic Models; Medicine; Medicine & Public Health; Middle Aged; Original Article; Ovarian cancer; Pelvic organ prolapse; Pelvic Organ Prolapse - surgery; Practice Patterns, Physicians' - statistics & numerical data; Propensity Score; Salpingectomy - methods; Salpingectomy - statistics & numerical data; Treatment Outcome; United States; Urology; United States; United States > US; Gynecology; Vaginal; Database; Pelvic organ prolapse; Salpingectomy; Hysterectomy; Health services research
• ISSN: 0937-3462; 1433-3023; 1433-3023
• DOI: 10.1007/s00192-019-03967-0

Introduction and hypothesis Preoperative counseling about salpingectomy with pelvic surgery is recommended by the American College of Obstetrics and Gynecology for ovarian cancer risk reduction. Our objective was to determine recent practice patterns and patient factors associated with salpingectomy with vaginal hysterectomy (VH) for pelvic organ prolapse (POP) in the USA. We hypothesize that salpingectomy might have become more common in recent years. Methods We queried the 2014–2016 National Surgical Quality Improvement Program database for women with a postoperative diagnosis of POP who underwent VH with any combination of pelvic reconstructive procedures. CPT codes do not differentiate salpingectomy from salpingo-oophorectomy, so subjects were stratified by whether concurrent adnexectomy was performed. Chi-squared and multivariate logistic regression analyses were used to evaluate characteristics associated with adnexectomy. Propensity score matching was utilized when evaluating postoperative complication rates. Results Of 5,344 women who underwent VH, 2019 (37.8%) had adnexectomy. Adnexectomy rate increased from 34.4% in 2014 to 46.8% in 2016 ( p  < 0.001). Adnexectomy rates of fellowship-trained urogynecologists and general gynecologists were similar (36.0% vs 38.8%, p  = 0.197). On logistic regression analysis, patients more likely to undergo adnexectomy were < 65 years old (OR 0.844, CI 0.75–0.95, p  = 0.004), had BMI <30 (OR 0.76, CI 0.68–0.86, p  < 0.001), and were non-smokers (OR 0.78, CI 0.64–0.95, p  = 0.016). Mean operative time was 17 min longer with adnexectomy (145 vs 128 min, p  < 0.001). There were no differences in postoperative complications or reoperation rates between groups. Conclusions Adnexectomy during VH for POP is safe and increasingly utilized by gynecology surgeons in the USA.