Salpingectomy versus tubal occlusion for permanent contraception during cesarean delivery: Outcomes and physician attitudes
Levy D, Casey S, Zemtsov G, Whiteside JL. Salpingectomy versus tubal occlusion for permanent contraception during cesarean delivery: outcomes and physician attitudes. J Minim Invasive Gynecol. doi: 10.1016/j.jmig.2020.07.025. [Epub ahead of print]
STUDY OBJECTIVE: Compare clinical outcomes and physician attitudes toward tubal occlusion and salpingectomy during cesarean section.
DESIGN: Retrospective cohort study with survey.
SETTING: Private hospital in Cincinnati, Ohio.
PATIENTS: Women aged ≥18 years undergoing permanent contraception during cesarean delivery with and without salpingectomy from January 2016 to December 2017.
INTERVENTIONS: Rate measurements of permanent contraception during cesarean section by salpingectomy versus tubal occlusion. Online survey assessment of study population physicians' attitudes toward salpingectomy.
MEASUREMENTS AND MAIN RESULTS: Study subjects identified using Current Procedural Terminology codes. Subject demographics, operative details, and perioperative morbidity indicators were identified by chart review. A total of 363 subjects were included: 116 (32%) had salpingectomies, and 247 (68%) had tubal occlusions. Study variables were compared using Wilcoxon rank sum and Fisher exact tests. Despite similar cohort demographics, salpingectomy increased mean operative time by 6.5 minutes compared with tubal occlusion (p = .001). Compared with subjects who had a salpingectomy, those who had a tubal occlusion had more postoperative symptomatic anemia (5.7% vs 0.9%) and infection (6.9% vs 1.7%). The primary surgeon was identified by logistic regression as the factor most predictive of salpingectomy (p <.001). Of 30 physicians, 23 (77%) completed the survey, and these physicians performed 80% of procedures. Physicians did not differ by sex, age, years of practice, solo vs group practice, or hospital-employed vs private practice when compared with the number or rate of salpingectomies performed. Cancer risk reduction was the most common physician-identified salpingectomy benefit (17 of 23, 74%). A total of 65% believed that salpingectomy posed additional risks, but 70% believed the benefits were equal to or greater than the risks. Of the 23 (87%) who completed the survey, 20 believed that salpingectomy added no additional operative time and was cost-neutral.
CONCLUSION: Relative to tubal ligation, salpingectomy during cesarean section increases operative time but not perioperative morbidity. Physicians do not seem biased against salpingectomy and express awareness of published benefits and risks, yet it is not the dominant surgical approach.