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Adnexectomy at the time of vaginal hysterectomy for pelvic organ prolapse

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Abstract

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.

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Authors and Affiliations

  1. Division of Female Pelvic Medicine and Reconstructive Surgery, Urology Institute, University Hospitals Cleveland Medical Center, 11100 Euclid Avenue, Lakeside Building, Suite 4554, Office #4568, Cleveland, OH, 44106, USA

    Emily A. Slopnick, David D. Sheyn, Graham C. Chapman, Sangeeta T. Mahajan, Sharif El-Nashar & Adonis K. Hijaz

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  1. Emily A. Slopnick
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  2. David D. Sheyn
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  3. Graham C. Chapman
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Correspondence to Emily A. Slopnick.

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A K Hijaz is a member of the Astellas, Inc. Speaker’s Bureau.

S T Mahajan is a member of the Astellas, Inc. Speaker’s Bureau and receives grant funding from Allergan, Inc.

The remaining authors have no financial disclosures or conflicts of interest to report.

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Appendix

Appendix

Table 5 Patient characteristics associated with adnexectomy at the time of vaginal hysterectomy for pelvic organ prolapse in a propensity score matched cohort
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Slopnick, E.A., Sheyn, D.D., Chapman, G.C. et al. Adnexectomy at the time of vaginal hysterectomy for pelvic organ prolapse. Int Urogynecol J 31, 373–379 (2020). https://doi.org/10.1007/s00192-019-03967-0

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