Patient reported experiences following laparoscopic prophylactic bilateral salpingo-oophorectomy or salpingectomy in an ambulatory care hospital

Abstract

Women at risk of developing ovarian cancer because of a BRCA1 or BRCA2 pathogenic variant are candidates for prophylactic bilateral salpingo-oophorectomy (BSO). While BSO surgeries are routinely performed, to our knowledge there are no studies that have examined patient-reported experiences following laparoscopic BSO performed in an ambulatory care setting. The objective of this study was to examine whether women undergoing prophylactic laparoscopic BSO felt they were adequately informed about post-operative outcomes. A telephone interview was conducted among 46 women undergoing laparoscopic BSO to collect detailed information regarding surgical outcomes, complications, symptoms, and time to return to daily activities. The average age at surgery was 45.0 years (range 34–66) and 67% of women underwent BSO prior to age 50. The mean reported hospital stay was 7.2 h (range 4–12 h) and at time of discharge, 78% of the women felt well enough to go home. None of the women required a readmission to hospital. Forty-three percent (n = 20) of the women did not feel well informed about what to expect post-operatively. Most of the patient-reported outcomes (including pain, vaginal bleeding, and nausea/vomiting) were expected and patient-reported menopausal symptoms were more common among women who were premenopausal at surgery. In terms of returning to regular activities, premenopausal women (n = 36) resumed sexual activity on average at 43 days (range 2–365), which is later than postmenopausal women (n = 15) at 19 days (range 7–30). On average, women returned to full-time work in 16 days (range 1–56 days). Despite patients receiving pre-surgery counselling, our findings suggest that there is a need to provide supplemental, reinforcing patient materials in preparing patients for what to expect after surgery.

This is a preview of subscription content, log in to check access.

Data availability

All data relevant to the study are included in the article.

References

  1. 1.

    Xie L, Semenciw R, Mery L (2015) Cancer incidence in Canada: trends and projections (1983–2032). Health Promot Chronic Dis Prev Can 35(Suppl 1):2–186

    Article  Google Scholar 

  2. 2.

    Kotsopoulos J, Gronwald J, Karlan B et al (2018) Age-specific ovarian cancer risks among women with a BRCA1 or BRCA2 mutation. Gynecol Oncol 150:85–91

    Article  Google Scholar 

  3. 3.

    Armstrong K, Sanford Schwartz J, Randall T, Rubin SC, Weber B (2004) Hormone replacement therapy and life expectancy after prophylactic oophorectomy in women with BRCA1/2 mutations: a decision analysis. J Clin Oncol 22:1045–1054

    Article  Google Scholar 

  4. 4.

    National Comprehensive Cancer Network. Genetic/familial high-risk assessment: breast and ovarian. NCCN Guidelines version 3.2019. Accessed 21 May 2019.

  5. 5.

    Gien LT, Kupets R, Covens A (2011) Feasibility of same-day discharge after laparoscopic surgery in gynecologic oncology. Gynecol Oncol 121:339–343

    Article  Google Scholar 

  6. 6.

    Dedden SJ, Geomini PMAJ, Huirne JAF, Bongers MY (2017) Vaginal and laparoscopic hysterectomy as an outpatient procedure: a systematic review. Eur J Obstet Gynecol Reprod Biol 216:212–223

    Article  Google Scholar 

  7. 7.

    Friedlander DF, Krimphove MJ, Cole AP et al (2019) Where is the value in ambulatory verses inpatient surgery? Ann Surg. https://doi.org/10.1097/SLA.0000000000003578

    Article  PubMed  Google Scholar 

  8. 8.

    Lozada Y, Bhagavath B (2017) A Review of laparoscopic salpingo-oophorectomy: technique and perioperative considerations. J Minim Invasive Gynecol 24:364–370

    Article  Google Scholar 

  9. 9.

    Gendy R, Walsh CA, Walsh SR, Karantanis E (2011) Vaginal hysterectomy versus total laparoscopic hysterectomy for benign disease: a metaanalysis of randomized controlled trials. Am J Obstet Gynecol 204:388.e1-8

    Article  Google Scholar 

  10. 10.

    Yi YX, Zhang W, Zhou Q, Guo WR, Su Y (2011) Laparoscopic-assisted vaginal hysterectomy vs abdominal hysterectomy for benign disease: a meta-analysis of randomized controlled trials. Eur J Obstet Gynecol Reprod Biol 159:1–18

    Article  Google Scholar 

  11. 11.

    Zhang Z, Zhuang Y, Ouyang F, Zhang A, Zeng B, Gu M (2012) Penehyclidine enhances the efficacy of tropisetron in prevention of PONV following gynecological laparoscopic surgery. J Anesth 26:864–869

    CAS  Article  Google Scholar 

  12. 12.

    Acalovschi I (2002) Postoperative nausea and vomiting. Curr Anaesth Crit Care 13:37–43

    Article  Google Scholar 

  13. 13.

    Tas B, Donatsky AM, Gogenur I (2013) Techniques to reduce shoulder pain after laparoscopic surgery for benign gynaecological disease: a systematic review. Gynecol Surg 10:169–175

    Article  Google Scholar 

  14. 14.

    Hohlrieder M, Brimacombe J, Eschertzhuber S, Ulmer H, Keller C (2007) A study of airway management using the ProSeal LMA compared with the tracheal tube on postoperative analgesia requirements following gynecological laparoscopic surgery. Anaesthesia 62:913–918

    CAS  Article  Google Scholar 

  15. 15.

    Kaloo P, Armstrong S, Kaloo C, Jordan V (2019) Interventions to reduce shoulder pain following gynaecological laparoscopic procedures. Cochrane Database Syst Rev 1:CD011101

    PubMed  Google Scholar 

  16. 16.

    Hayden P, Cowman S (2011) Anaesthesia for laparoscopic surgery. Contin Educ Anaesth Crit Care Pain 11:177–180

    Article  Google Scholar 

  17. 17.

    Dixon JB, Reuben Y, Halket C, O’Brien PE (2005) Shoulder pain is a common problem following laparoscopic adjustable gastric band surgery. Obes Surg 15:1111–1117

    Article  Google Scholar 

  18. 18.

    Wang JJ, Ho ST, Liu HS, Ho CM (2000) Prophylactic antiemetic effect of dexamethasone in women undergoing ambulatory laparoscopic surgery. Br J Anaesth 84:459–462

    CAS  Article  Google Scholar 

  19. 19.

    Michelsen TM, Dorum A, Trope CG, Fossa SD, Dahl AA (2009) Fatigue and quality of life after risk-reducing salpingo-oophorectomy in women at increased risk for hereditary breast-ovarian cancer. Int J Gynecol Cancer 19:1029–1036

    Article  Google Scholar 

  20. 20.

    Corney RH, Crowther ME, Everett H, Howells A, Shepherd JH (1993) Psychosexual dysfunction in women with gynaecological cancer following radical pelvic surgery. Br J Obstet Gynaecol 100:73–78

    CAS  Article  Google Scholar 

  21. 21.

    Fang CY, Cherry C, Devarajan K, Li T, Malick J, Daly MB (2009) A prospective study of quality of life among women undergoing risk-reducing salpingo-oophorectomy versus gynecologic screening for ovarian cancer. Gynecol Oncol 112:594–600

    Article  Google Scholar 

  22. 22.

    Hall E, Finch A, Jacobson M et al (2019) Effects of bilateral salpingo-oophorectomy on menopausal symptoms and sexual functioning among women with a BRCA1 or BRCA2 mutation. Gynecol Oncol 152:145–150

    CAS  Article  Google Scholar 

  23. 23.

    Tucker PE, Bulsara MK, Salfinger SG, Jit-Sun Tan J, Green H, Cohen PA (2016) The effects of pre-operative menopausal status and hormone replacement therapy (HRT) on sexuality and quality of life after risk-reducing salpingo-oophorectomy. Maturitas 85:42–48

    CAS  Article  Google Scholar 

  24. 24.

    Sanders AP, Amir H, Fong CJ, Murji A, Solnik MJ (2020) Returning to work following minimally invasive hysterectomy. J Obstet Gynaecol Can 42:80–83

    Article  Google Scholar 

  25. 25.

    Bouwsma EVA, Anema JR, Vonk Noordegraaf A, de Vet HCW, Huirne JAF (2017) Using patient data to optimize an expert-based guideline on convalescence recommendations after gynecological surgery: a prospective cohort study. BMC Surg 17:129

    Article  Google Scholar 

  26. 26.

    Horvath KJ (2003) Postoperative recovery at home after ambulatory gynecologic laparoscopic surgery. J Perianesth Nurs 18:324–334

    Article  Google Scholar 

  27. 27.

    Kleinbeck SVM, Eells KR (1997) Monitoring postdischarge ambulatory surgical recovery costs and outcomes. Surg Serv Manag 3:33–35

    Google Scholar 

  28. 28.

    Oberle K, Allen M, Lynkowski P (1994) Follow-up of same day surgery patients: a study of patient concerns. AORN J 59:1016–1025

    CAS  Article  Google Scholar 

  29. 29.

    Alshenqeeti H (2014) Interviewing as a data collection method: a critical review. Engl Linguist Res 3:39–45

    Google Scholar 

Download references

Acknowledgements

Our sincere gratitude to the women who participated in the study interviews and enabled this research to take place.

Funding

Steven A. Narod is the recipient of a Canada Research Chair (Tier I). Joanne Kotsopoulos is a recipient of a Tier II Canada Research Chair. This study was supported by a Canadian Cancer Society Research Institute Grant (703058) and the Peter Gilgan Centre for Women’s Cancers at Women’s College Hospital, in partnership with the Canadian Cancer Society. Funding sources had no involvement in any aspect of study activity.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Joanne Kotsopoulos.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

IRB

February 22, 2019—2019-0006-E.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Trister, R., Jacobson, M., Nguyen, P. et al. Patient reported experiences following laparoscopic prophylactic bilateral salpingo-oophorectomy or salpingectomy in an ambulatory care hospital. Familial Cancer (2020). https://doi.org/10.1007/s10689-020-00208-y

Download citation

Keywords

  • BRCA
  • Oophorectomy
  • Ambulatory care
  • Patient reported outcomes